Case management: a case study.

PubMed

Stanton, M P; Walizer, E M; Graham, J I; Keppel, L

2000-01-01

This article describes the implementation of a pilot case management program at Walter Reed Army Medical Center. I, it we discuss obvious pitfalls and problems implementing case management in a large multiservice center and the steps and processes implemented to expedite and move case management forward in its early stages. The insights shared may be useful for those implementing case management in a complex medical center situation. Other models used in similar situations are also reviewed.

A process evaluation of a social cognitive theory-based childhood obesity prevention intervention: the Comics for Health program.

PubMed

Branscum, Paul; Sharma, Manoj; Wang, Lihshing Leigh; Wilson, Bradley; Rojas-Guyler, Liliana

2013-03-01

Process evaluations are an often overlooked yet essential component of health promotion interventions. This study reports the results of a comprehensive process evaluation for the "Comics for Health" program, a childhood obesity prevention intervention implemented at 12 after-school programs. Qualitative and quantitative process data were collected using surveys, field notes, and open-item questionnaires, which assessed program fidelity, dose delivered, dose received, reach, recruitment, and context. Triangulation of methods was also employed to better understand how the program was implemented and received by the facilitator, staff members, and children in the program. Results indicated that program implementation had an almost perfect rate of fidelity with most lessons recording 100% tasks completed. Lessons were implemented in their intended order and lasted approximately 30 minutes as planned. After-school staff members reported that the program was well received by children, and this program should be replicated in the future. Attendance records showed that a majority of the children attended each lesson on the initial day of delivery (70.4%) and informal make-up lessons were implemented to compensate for the other children. Finally, several known sources of contamination were found such as past and concurrent exposure to similar health promotion interventions, which could potentially influence study outcomes. These findings will be used to help explain the results of this intervention and make recommendations for future intervention efforts.

Applying successfully proven measures in roadway safety to reduce harmful collisions in SC.

DOT National Transportation Integrated Search

2017-06-06

The overall goal of this research was to identify proven successful safety programs used in other states and assess the potential for safety improvement if similar programs were implemented in South Carolina. The research team not only sought out eng...

A facility-wide approach to recreation programming for adults who are severely and profoundly retarded.

PubMed

Burch, M R; Reiss, M; Bailey, J S

1985-01-01

A facility-wide recreation program was designed and implemented in order to increase staff and client participation in daily leisure activities at an intermediate care facility for severely and profoundly mentally retarded adults. The baseline phase of the study consisted of having recreational materials available during scheduled recreation periods. The treatment was a package program consisting of (1) providing the staff with preplanned materials and activities, (2) assigning staff to specific roles, and (3) monitoring staff and providing feedback by supervisors. The treatment was implemented on the two living units of the Liberty Intermediate Care Facility. Treatment effects were similar on both units. Client participation increased from a baseline average of less than 10% to nearly 50% and staff participation increased from less than 10% to an average of 60% during program implementation.

Implementation of Turnaround Strategies in Chronically Low-Performing Schools

ERIC Educational Resources Information Center

Turnbull, Brenda J.; Arcaira, Erikson R.

2012-01-01

There is some evidence to indicate that chronically low-performing schools, whether improving student performance or not, often report pursuing substantially similar policies, programs, and practices. However, while chronically low-performing schools may pursue similar school improvement strategies, there is some evidence that the level and…

APPLYING LESSONS LEARNED FROM THE UNITED STATES SPECIAL OPERATIONS COMMAND’S HUMAN PERFORMANCE PROGRAM TO THE UNITED STATES AIR FORCES COMPREHENSIVE AIRMAN FITNESS

DTIC Science & Technology

2016-04-01

implementation, focusing physical training on the mission specific requirements of the individual similar to an athletic sports model, increasing access to...initiative as a mechanism to help maintain the resiliency, health, and welfare of its force.1 As Air Force Instruction (AFI) 90-506 states, the strategy ...implementation of Tactical Athlete Programs, which provide tailored workout plans and nutrition education that prepare service members to meet the physical

Implementation of R & QA practices in Research and Development programs

NASA Technical Reports Server (NTRS)

Bankaitis, H.

1983-01-01

DOE has established a number of broad programs aimed at reducing fuel consumption. Several programs address the R&D of ground transportation propulsion alternatives to the conventional spark-ignition engine. NASA Lewis is responsible for managing the effort between the Government and industry teams involving American and foreign companies. Thus, existing NASA SR&QA procedure were modified/adapted to these R&D programs and implemented to assure that the test hardware design intent was met, the hardware was not hazardous to personnel, it would demonstrate reliable operation, and it would help establish the future R&D quality assurance and maintainability requirements. This successful low-cost approach might be applicable to other similar projects.

School Culture Benchmarks: Bridges and Barriers to Successful Bullying Prevention Program Implementation

ERIC Educational Resources Information Center

Coyle, H. Elizabeth

2008-01-01

A substantial body of research indicates that positive school culture benchmarks are integrally tied to the success of school reform and change in general. Additionally, an emerging body of research suggests a similar role for school culture in effective implementation of school violence prevention and intervention efforts. However, little…

Leadership: Self, School, Community.

ERIC Educational Resources Information Center

Maher, Robert

This book describes Character Development and Leadership Training in the School and Community, a high school course instituted at Lakeland High School in Shrub Oak, New York in 1983. It was written to help other educators interested in implementing similar student leadership programs. The developer of the program explains some of his reasons for…

Comparison of the Partner Institutions' Perceptions of the Cross-Border Higher Education Program and the Impact on Program Implementation: Case Studies of Two Sino-U.S. Business Management Programs

ERIC Educational Resources Information Center

Jie, Yiyun

2011-01-01

This study examined discrepancies and similarities between the partner institutions' perceptions of the motivations, expected outcomes, and desired strategies achieving such outcomes in their cross-border higher educational programs from a game theory perspective, in the context of Mainland China (hereafter referred to as China). By comparing the…

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

A Checklist-based Intervention to Improve Surgical Outcomes in Michigan: Evaluation of the Keystone Surgery Program

PubMed Central

Reames, Bradley N.; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

2015-01-01

Importance Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective To evaluate whether implementation of a checklist-based quality improvement intervention, Keystone Surgery, was associated with improved outcomes in patients undergoing general surgery in large statewide population. Design, Setting and Exposure Retrospective longitudinal study examining surgical outcomes in Michigan patients using Michigan Surgical Quality Collaborative clinical registry data from the years 2006–2010 (n=64,891 patients in 29 hospitals). Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcome Measures Risk-adjusted rates of superficial surgical site infection, wound complications, any complication, and 30-day mortality. Results Implementation of Keystone Surgery in participating centers (n=14 hospitals) was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2 vs. 3.2%, p=0.91), wound complications (5.9 vs. 6.5%, p=0.30), any complication (12.4 vs. 13.2%, p=0.26), and 30-day mortality (2.1 vs. 1.9%, p=0.32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in non-participating centers (n=15 hospitals), and sensitivity analysis excluding patients receiving surgery in the first 6- or 12-months after program implementation yielded similar results. Conclusions and Relevance Implementation of a checklist-based quality improvement intervention did not impact rates of adverse surgical outcomes among patients undergoing general surgery in participating Michigan hospitals. Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations. PMID:25588183

Evaluating the Dissemination of "Body & Soul," an Evidence-based Fruit and Vegetable Intake Intervention: Challenges for Dissemination and Implementation Research

ERIC Educational Resources Information Center

Allicock, Marlyn; Campbell, Marci K.; Valle, Carmina G.; Carr, Carol; Resnicow, Ken; Gizlice, Ziya

2012-01-01

Objective: To evaluate whether the evidence-based "Body & Soul" program, when disseminated and implemented without researcher or agency involvement and support, would achieve results similar to those of earlier efficacy and effectiveness trials. Design: Prospective group randomized trial. Setting: Churches with predominantly African American…

A sustainable dietetics bridging program: development and implementation in Atlantic Canada.

PubMed

Lordly, Daphne; Guy, Jennifer; Barry, Paula; Garus, Jennifer

2014-01-01

A provincial focus on immigration and improved foreign credential recognition has led to an investigation of best practices and subsequent recommendations for the development and implementation of a sustainable university-based bridging program for internationally educated dietitians in Atlantic Canada. Data were collected from various sources and used to inform program decisions and direction. An advisory framework was established through a core group representing dietetics education and regulation and internationalization. Subsequently, a key stakeholder group was formed. As a result of this collaboration and research, a dietetics bridging framework was developed and a program pilot tested. Lessons learned may inform similar endeavours and highlight the importance of collaborative leadership and collaboration among multiple stakeholders, and of creatively addressing program sustainability issues while keeping learners (internationally educated dietitians) at the centre.

Providing an Optimal School Context for Talent Development: An Extended Curriculum Program in Practice

ERIC Educational Resources Information Center

Kronborg, Leonie; Plunkett, Margaret

2015-01-01

Developing the talents of academically able students in government secondary schools in Victoria, Australia, has recently gained support through the expansion of Select Entry Accelerated Learning (SEAL) Programs. In the private sector, a similar expansion of interest in talent development has occurred through the development and implementation of…

Thinking outside the Four Walls of the Classroom: A Canadian Nature Kindergarten

ERIC Educational Resources Information Center

Elliot, Enid; Krusekopf, Frances

2017-01-01

The authors share a narrative of planning and implementing a Nature Kindergarten in the public school system in British Columbia, Canada. Inspired by similar programs in Northern Europe, the Nature Kindergarten became the first program of its kind in Western Canada. The importance of developing pedagogical principles, understanding local context…

Motives as predictors of the public's attitudes toward solid waste issues

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ebreo, A.; Vining, J.

2000-02-01

Surveys focusing on solid-waste-related issues, conducted over a period of several years, provided data from independent samples of residents of a Midwestern, USA, community. The collection of these data yielded useful information about the relationship between residents' recycling motives and their attitudes toward solid waste management in light of several changes in the solid waste infrastructure of the community over that time. The initial survey assessed baseline beliefs and attitudes, while later surveys were conducted after the implementation of a community educational program and a curbside recycling program. The findings indicated that for recyclers and nonrecyclers, different motives predicted endorsementmore » of solid waste programs and policies. Although a similar percentage of recyclers and nonrecyclers were in support of various proposed programs and policies, concern for the environment was found to be positively related to nonrecyclers' support of proposed programs, particularly before these programs were implemented. Prior to program implementation, motives other than environmental altruism were found to be related to recyclers' support of the programs. Additional findings support the idea that educational programs and increased accessibility to recycling opportunities affect the relationship between people's attitudes toward solid waste management and their recycling motives.« less

A Comparison of Three Programming Models for Adaptive Applications

NASA Technical Reports Server (NTRS)

Shan, Hong-Zhang; Singh, Jaswinder Pal; Oliker, Leonid; Biswa, Rupak; Kwak, Dochan (Technical Monitor)

2000-01-01

We study the performance and programming effort for two major classes of adaptive applications under three leading parallel programming models. We find that all three models can achieve scalable performance on the state-of-the-art multiprocessor machines. The basic parallel algorithms needed for different programming models to deliver their best performance are similar, but the implementations differ greatly, far beyond the fact of using explicit messages versus implicit loads/stores. Compared with MPI and SHMEM, CC-SAS (cache-coherent shared address space) provides substantial ease of programming at the conceptual and program orchestration level, which often leads to the performance gain. However it may also suffer from the poor spatial locality of physically distributed shared data on large number of processors. Our CC-SAS implementation of the PARMETIS partitioner itself runs faster than in the other two programming models, and generates more balanced result for our application.

14 CFR 1216.204 - General implementation requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Unified National Program for Flood Plain Management (U.S. Water Resources Council, 1978). (1) Descriptive... permits and grants to enable them to similarly evaluate, in accordance with the Orders, the effects of...

14 CFR 1216.204 - General implementation requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Unified National Program for Flood Plain Management (U.S. Water Resources Council, 1978). (1) Descriptive... permits and grants to enable them to similarly evaluate, in accordance with the Orders, the effects of...

14 CFR 1216.204 - General implementation requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Unified National Program for Flood Plain Management (U.S. Water Resources Council, 1978). (1) Descriptive... permits and grants to enable them to similarly evaluate, in accordance with the Orders, the effects of...

14 CFR 1216.204 - General implementation requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Unified National Program for Flood Plain Management (U.S. Water Resources Council, 1978). (1) Descriptive... permits and grants to enable them to similarly evaluate, in accordance with the Orders, the effects of...

14 CFR § 1216.204 - General implementation requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Unified National Program for Flood Plain Management (U.S. Water Resources Council, 1978). (1) Descriptive... permits and grants to enable them to similarly evaluate, in accordance with the Orders, the effects of...

From Biological to Program Efficacy: Promoting Dialogue among the Research, Policy, and Program Communities12

PubMed Central

Habicht, Jean-Pierre; Pelto, Gretel H.

2014-01-01

The biological efficacy of nutritional supplements to complement usual diets in poor populations is well established. This knowledge rests on decades of methodologic research development and, more recently, on codification of methods to compile and interpret results across studies. The challenge now is to develop implementation (delivery) science knowledge and achieve a similar consensus on efficacy criteria for the delivery of these nutrients by public health and other organizations. This requires analysis of the major policy instruments for delivery and well-designed program delivery studies that examine the flow of a nutrient through a program impact pathway. This article discusses the differences between biological and program efficacy, and why elucidating the fidelity of delivery along the program impact pathways is essential for implementing a program efficacy trial and for assessing its internal and external validity. Research on program efficacy is expanding, but there is a lack of adequate frameworks to facilitate the process of harmonizing concepts and vocabulary, which is essential for communication among scientists, policy planners, and program implementers. There is an urgent need to elaborate these frameworks at national and program levels not only for program efficacy studies but also for the broader research agenda to support and improve the science of delivering adequate nutrition to those who need it most. PMID:24425719

Longitudinal Outcomes of an Institutionally Developed Nurse Residency Program

PubMed Central

Cline, Debbie; La Frentz, Kelly; Fellman, Bryan; Summers, Barbara; Brassil, Kelly

2017-01-01

Nurse residency programs are widely implemented to enhance integration of new graduate nurses entering the workforce. This article presents a retrospective analysis of 10 years of residency data from an internally developed residency program that utilized the Casey-Fink Graduate Nurse Experience Survey. Outcomes of this program were similar to those from studies using commercially available products, suggesting an internally developed residency curricula may be equally beneficial to the development of new graduate nurses. PMID:28727624

An Implementation Plan: One-to-One Laptop Program Recommendations for the Pittsgrove Township School District

ERIC Educational Resources Information Center

Brodzik, Michael C.

2012-01-01

This Executive Position Paper is a one-to-one laptop implementation plan for Pittsgrove Township Schools that can be used as a template for other districts with similar interests. Each of the three chapters fulfills a major purpose. In Chapter One the paper is designed to substantiate the need for the Pittsgrove Township School District to…

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy.

PubMed

Empey, Philip E; Stevenson, James M; Tuteja, Sony; Weitzel, Kristin W; Angiolillo, Dominick J; Beitelshees, Amber L; Coons, James C; Duarte, Julio D; Franchi, Francesco; Jeng, Linda J B; Johnson, Julie A; Kreutz, Rolf P; Limdi, Nita A; Maloney, Kristin A; Owusu Obeng, Aniwaa; Peterson, Josh F; Petry, Natasha; Pratt, Victoria M; Rollini, Fabiana; Scott, Stuart A; Skaar, Todd C; Vesely, Mark R; Stouffer, George A; Wilke, Russell A; Cavallari, Larisa H; Lee, Craig R

2017-12-26

CYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes, which are both related to the CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions. © 2018, The American Society for Clinical Pharmacology and Therapeutics.

VHA mental health information system: applying health information technology to monitor and facilitate implementation of VHA Uniform Mental Health Services Handbook requirements.

PubMed

Trafton, Jodie A; Greenberg, Greg; Harris, Alex H S; Tavakoli, Sara; Kearney, Lisa; McCarthy, John; Blow, Fredric; Hoff, Rani; Schohn, Mary

2013-03-01

To describe the design and deployment of health information technology to support implementation of mental health services policy requirements in the Veterans Health Administration (VHA). Using administrative and self-report survey data, we developed and fielded metrics regarding implementation of the requirements delineated in the VHA Uniform Mental Health Services Handbook. Finalized metrics were incorporated into 2 external facilitation-based quality improvement programs led by the VHA Mental Health Operations. To support these programs, tailored site-specific reports were generated. Metric development required close collaboration between program evaluators, policy makers and clinical leadership, and consideration of policy language and intent. Electronic reports supporting different purposes required distinct formatting and presentation features, despite their having similar general goals and using the same metrics. Health information technology can facilitate mental health policy implementation but must be integrated into a process of consensus building and close collaboration with policy makers, evaluators, and practitioners.

The New York State Model for Sharing Successful Programs: A Decade of Implementation and Evaluation.

ERIC Educational Resources Information Center

Egelston, Richard L.

To address educational reform needs in New York State, the State Education Department developed a research-based Sharing Successful Practices (SSP) Dissemination model. Under SSP, a program successful in meeting one district's needs can be adopted by other districts with similar needs. SSP has four components: validation, demonstration,…

Capacity development for health research in Africa: experiences managing the African Doctoral Dissertation Research Fellowship Program

PubMed Central

2010-01-01

Africa's progress depends on her capacity to generate, adapt, and use scientific knowledge to meet regional health and development needs. Yet, Africa's higher education institutions that are mandated to foster this capacity lack adequate resources to generate and apply knowledge, raising the need for innovative approaches to enhance research capacity. In this paper, we describe a newly-developed program to support PhD research in health and population sciences at African universities, the African Doctoral Dissertation Research Fellowship (ADDRF) Program. We also share our experiences implementing the program. As health research capacity-strengthening in Africa continues to attract attention and as the need for such programs to be African-led is emphasized, our experiences in developing and implementing the ADDRF offer invaluable lessons to other institutions undertaking similar initiatives. PMID:20587016

Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality.

PubMed

Walrath, Christine; Garraza, Lucas Godoy; Reid, Hailey; Goldston, David B; McKeon, Richard

2015-05-01

We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.

The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice.

PubMed

Henderson, Amanda J; Davies, Jan; Willet, Michaela R

2006-11-01

This paper describes a qualitative program evaluation which sought to identify factors that either assist or impede the adoption of clinical evidence in everyday practice. Thirteen Australian projects were funded in a competitive grant program to adopt innovative strategies to improve the uptake of research evidence in everyday clinical practice. Project leaders' reports were analysed to collate common themes related to 1) critical elements in successful application of research knowledge, 2) barriers to implementing evidence, and 3) lessons for other organisations that might implement a similar project. Despite the diversity of the methods used to establish projects and the range of topics and clinical settings, many similarities were identified in the perceived critical success elements, barriers, and lessons for adopting clinical evidence. Eighteen themes emerged across the data including: leadership support; key stakeholder involvement; practice changes; communication; resources; education of staff; evaluation of outcomes; consumers; knowledge gaps; adoption/implementing staff; access to knowledge; risk assessment; collaboration; effectiveness of clinical research evidence; structure/organisation; cultural barriers; previous experiences; and information technology. Leaders of projects to adopt evidence in clinical practice identified barriers, critical success elements and lessons that impacted on their projects. A range of influences on the adoption of evidence were identified, and this knowledge can be used to assist others undertaking similar projects.

SS-Wrapper: a package of wrapper applications for similarity searches on Linux clusters.

PubMed

Wang, Chunlin; Lefkowitz, Elliot J

2004-10-28

Large-scale sequence comparison is a powerful tool for biological inference in modern molecular biology. Comparing new sequences to those in annotated databases is a useful source of functional and structural information about these sequences. Using software such as the basic local alignment search tool (BLAST) or HMMPFAM to identify statistically significant matches between newly sequenced segments of genetic material and those in databases is an important task for most molecular biologists. Searching algorithms are intrinsically slow and data-intensive, especially in light of the rapid growth of biological sequence databases due to the emergence of high throughput DNA sequencing techniques. Thus, traditional bioinformatics tools are impractical on PCs and even on dedicated UNIX servers. To take advantage of larger databases and more reliable methods, high performance computation becomes necessary. We describe the implementation of SS-Wrapper (Similarity Search Wrapper), a package of wrapper applications that can parallelize similarity search applications on a Linux cluster. Our wrapper utilizes a query segmentation-search (QS-search) approach to parallelize sequence database search applications. It takes into consideration load balancing between each node on the cluster to maximize resource usage. QS-search is designed to wrap many different search tools, such as BLAST and HMMPFAM using the same interface. This implementation does not alter the original program, so newly obtained programs and program updates should be accommodated easily. Benchmark experiments using QS-search to optimize BLAST and HMMPFAM showed that QS-search accelerated the performance of these programs almost linearly in proportion to the number of CPUs used. We have also implemented a wrapper that utilizes a database segmentation approach (DS-BLAST) that provides a complementary solution for BLAST searches when the database is too large to fit into the memory of a single node. Used together, QS-search and DS-BLAST provide a flexible solution to adapt sequential similarity searching applications in high performance computing environments. Their ease of use and their ability to wrap a variety of database search programs provide an analytical architecture to assist both the seasoned bioinformaticist and the wet-bench biologist.

SS-Wrapper: a package of wrapper applications for similarity searches on Linux clusters

PubMed Central

Wang, Chunlin; Lefkowitz, Elliot J

2004-01-01

Background Large-scale sequence comparison is a powerful tool for biological inference in modern molecular biology. Comparing new sequences to those in annotated databases is a useful source of functional and structural information about these sequences. Using software such as the basic local alignment search tool (BLAST) or HMMPFAM to identify statistically significant matches between newly sequenced segments of genetic material and those in databases is an important task for most molecular biologists. Searching algorithms are intrinsically slow and data-intensive, especially in light of the rapid growth of biological sequence databases due to the emergence of high throughput DNA sequencing techniques. Thus, traditional bioinformatics tools are impractical on PCs and even on dedicated UNIX servers. To take advantage of larger databases and more reliable methods, high performance computation becomes necessary. Results We describe the implementation of SS-Wrapper (Similarity Search Wrapper), a package of wrapper applications that can parallelize similarity search applications on a Linux cluster. Our wrapper utilizes a query segmentation-search (QS-search) approach to parallelize sequence database search applications. It takes into consideration load balancing between each node on the cluster to maximize resource usage. QS-search is designed to wrap many different search tools, such as BLAST and HMMPFAM using the same interface. This implementation does not alter the original program, so newly obtained programs and program updates should be accommodated easily. Benchmark experiments using QS-search to optimize BLAST and HMMPFAM showed that QS-search accelerated the performance of these programs almost linearly in proportion to the number of CPUs used. We have also implemented a wrapper that utilizes a database segmentation approach (DS-BLAST) that provides a complementary solution for BLAST searches when the database is too large to fit into the memory of a single node. Conclusions Used together, QS-search and DS-BLAST provide a flexible solution to adapt sequential similarity searching applications in high performance computing environments. Their ease of use and their ability to wrap a variety of database search programs provide an analytical architecture to assist both the seasoned bioinformaticist and the wet-bench biologist. PMID:15511296

A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention

PubMed Central

Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

2016-01-01

Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA (‘Sisters Informing Sisters on Topics about acquired immune deficiency syndrome’), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training. PMID:26944867

Westinghouse corporate development of a decision software program for Radiological Evaluation Decision Input (REDI)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bush, T.S.

1995-03-01

In December 1992, the Department of Energy (DOE) implemented the DOE Radiological Control Manual (RCM). Westinghouse Idaho Nuclear Company, Inc. (WINCO) submitted an implementation plan showing how compliance with the manual would be achieved. This implementation plan was approved by DOE in November 1992. Although WINCO had already been working under a similar Westinghouse RCM, the DOE RCM brought some new and challenging requirements. One such requirement was that of having procedure writers and job planners create the radiological input in work control procedures. Until this time, that information was being provided by radiological engineering or a radiation safety representative.more » As a result of this requirement, Westinghouse developed the Radiological Evaluation Decision Input (REDI) program.« less

Facilitating change in health-related behaviors and intentions: a randomized controlled trial of a multidimensional memory program for older adults.

PubMed

Wiegand, Melanie A; Troyer, Angela K; Gojmerac, Christina; Murphy, Kelly J

2013-01-01

Many older adults are concerned about memory changes with age and consequently seek ways to optimize their memory function. Memory programs are known to be variably effective in improving memory knowledge, other aspects of metamemory, and/or objective memory, but little is known about their impact on implementing and sustaining lifestyle and healthcare-seeking intentions and behaviors. We evaluated a multidimensional, evidence-based intervention, the Memory and Aging Program, that provides education about memory and memory change, training in the use of practical memory strategies, and support for implementation of healthy lifestyle behavior changes. In a randomized controlled trial, 42 healthy older adults participated in a program (n = 21) or a waitlist control (n = 21) group. Relative to the control group, participants in the program implemented more healthy lifestyle behaviors by the end of the program and maintained these changes 1 month later. Similarly, program participants reported a decreased intention to seek unnecessary medical attention for their memory immediately after the program and 1 month later. Findings support the use of multidimensional memory programs to promote healthy lifestyles and influence healthcare-seeking behaviors. Discussion focuses on implications of these changes for maximizing cognitive health and minimizing impact on healthcare resources.

Implementation of herd health program to improve survival of Boer goats in Malaysia.

PubMed

Salisi, Mohd Shahrom; Saad, Mohd Zamri; Kasim, Azhar

2012-02-01

A Boer goat breeding farm with 800 heads of breeder females, 50 breeder males, and 400 growing goats of various ages in Sabah, Malaysia was selected to study the effect of implementing herd health program. This included vaccination program against pneumonic mannheimiosis; fecal monitoring for helminthiasis, coccidiosis, and colibacillosis; and introduction of modified feeding regime comprised of day-time grazing and feeding of cut grass and supplemented feed. The herd health program was implemented in September 2007 and the impact was observed on body weight gains, body scoring, and annual mortality among adults and kids. It was found that implementation of herd health program significantly (p < 0.05) increased the average body weight gains in both adults and kids from 1.8 g per kid and 0.6 g per adult in 2006 to 3.7 g per kid and 2.2 g per adult in 2008. The percentage of adults with body scoring of <3 was significantly (p < 0.05) reduced from 82.3% in 2006 to 77.6% in 2007 and 4% in 2008. Similarly, the annual mortality rate was significantly (p < 0.05) reduced from 6.5% among kids and 58.2% among adults in 2006 to 12.1% among kids and 10.4% among adults in 2007, and to 9.1% among kids and 1.1% among adults in 2008. Therefore, it was concluded that implementation of herd health program significantly improved the survival and performance of goats.

Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths.

PubMed

Godoy Garraza, Lucas; Walrath, Christine; Goldston, David B; Reid, Hailey; McKeon, Richard

2015-11-01

Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse. To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously. We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011. Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.

APhA 2011 REMS white paper: Summary of the REMS stakeholder meeting on improving program design and implementation.

PubMed

American Pharmacists Association; Bough, Marcie

2011-01-01

To develop an improved risk evaluation and mitigation strategies (REMS) system for maximizing effective and safe patient medication use while minimizing burden on the health care delivery system. 34 stakeholders gathered October 6-7, 2010, in Arlington, VA, for the REMS Stakeholder Meeting, convened by the American Pharmacists Association (APhA). Participants included national health care provider associations, including representatives for physicians, physician assistants, nurses, nurse practitioners, and pharmacists, as well as representatives for patient advocates, drug distributors, community pharmacists (chain and independent), drug manufacturer associations (brand, generic, and biologic organizations), and health information technology, standards, and safety organizations. Staff from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research participated as observers. The meeting built on themes from the APhA's 2009 REMS white paper. The current REMS environment presents many challenges for health care providers due to the growing number of REMS programs and the lack of standardization or similarities among various REMS programs. A standardized REMS process that focuses on maximizing patient safety and minimizing impacts on patient access and provider implementation could offset these challenges. A new process that includes effective provider interventions and standardized tools and systems for implementing REMS programs may improve patient care and overcome some of the communication issues providers and patients currently face. Metrics could be put in place to evaluate the effectiveness of REMS elements. By incorporating REMS program components into existing technologies and data infrastructures, achieving REMS implementation that is workflow neutral and minimizes administrative burden may be possible. An appropriate compensation model could ensure providers have adequate resources for patient care and REMS implementation. Overall, stakeholders should continue to work collaboratively with FDA and manufacturers to improve REMS program design and implementation issues. A workable REMS system will require effective patient interventions, standardized elements that limit barriers to implementation for both patients and providers, standardized yet flexible implementation strategies, use of existing technologies in practice settings, increased opportunities for provider input early in REMS design processes, improved communication strategies and awareness of program requirements, and viable provider compensation models needed to offset costs to implement and comply with REMS program requirements.

The transfer and implementation of an Aboriginal Australian wellbeing program: a grounded theory study

PubMed Central

2013-01-01

Background The concepts and standard practices of implementation, largely originating in developed countries, cannot necessarily be simply transferred into diverse cultural contexts. There has been relative inattention in the implementation science literature paid to the implementation of interventions targeting minority Indigenous populations within developed countries. This suggests that the implementation literature may be bypassing population groups within developed countries who suffer some of the greatest disadvantage. Within the context of Aboriginal Australian health improvement, this study considers the impact of political and cultural issues by examining the transfer and implementation of the Family Wellbeing program across 56 places over a 20-year period. Methods A theoretical model of program transfer was developed using constructivist-grounded theory methods. Data were generated by conducting in-depth interviews with 18 Aboriginal and non-Aboriginal research respondents who had been active in transferring the program. Data were categorised into higher order abstract concepts and the core impetus for and process of program transfer were identified. Results Organizations transferred the program by using it as a vehicle for supporting inside-out empowerment. The impetus to support inside-out empowerment referred to support for Aboriginal people's participation, responsibility for and control of their own affairs, and the associated ripple effects to family members, organizations, communities, and ultimately reconciliation with Australian society at large. Program transfer occurred through a multi-levelled process of embracing relatedness which included relatedness with self, others, and structural conditions; all three were necessary at both individual and organizational levels. Conclusions Similar to international implementation models, the model of supporting inside-out empowerment by embracing relatedness involved individuals, organizations, and interpersonal and inter-organizational networks. However, the model suggests that for minority Indigenous populations within developed countries, implementation approaches may require greater attention to the empowering nature of the intervention and its implementation, and multiple levels of relatedness by individuals and organizations with self, others, and the structural conditions. Key elements of the theoretical model provide a useful blueprint to inform the transfer of other empowerment programs to minority Indigenous and other disadvantaged populations on a case-by-case basis. PMID:24171867

The transfer and implementation of an Aboriginal Australian wellbeing program: a grounded theory study.

PubMed

McCalman, Janya R

2013-10-31

The concepts and standard practices of implementation, largely originating in developed countries, cannot necessarily be simply transferred into diverse cultural contexts. There has been relative inattention in the implementation science literature paid to the implementation of interventions targeting minority Indigenous populations within developed countries. This suggests that the implementation literature may be bypassing population groups within developed countries who suffer some of the greatest disadvantage. Within the context of Aboriginal Australian health improvement, this study considers the impact of political and cultural issues by examining the transfer and implementation of the Family Wellbeing program across 56 places over a 20-year period. A theoretical model of program transfer was developed using constructivist-grounded theory methods. Data were generated by conducting in-depth interviews with 18 Aboriginal and non-Aboriginal research respondents who had been active in transferring the program. Data were categorised into higher order abstract concepts and the core impetus for and process of program transfer were identified. Organizations transferred the program by using it as a vehicle for supporting inside-out empowerment. The impetus to support inside-out empowerment referred to support for Aboriginal people's participation, responsibility for and control of their own affairs, and the associated ripple effects to family members, organizations, communities, and ultimately reconciliation with Australian society at large. Program transfer occurred through a multi-levelled process of embracing relatedness which included relatedness with self, others, and structural conditions; all three were necessary at both individual and organizational levels. Similar to international implementation models, the model of supporting inside-out empowerment by embracing relatedness involved individuals, organizations, and interpersonal and inter-organizational networks. However, the model suggests that for minority Indigenous populations within developed countries, implementation approaches may require greater attention to the empowering nature of the intervention and its implementation, and multiple levels of relatedness by individuals and organizations with self, others, and the structural conditions. Key elements of the theoretical model provide a useful blueprint to inform the transfer of other empowerment programs to minority Indigenous and other disadvantaged populations on a case-by-case basis.

Peer Advisors for Veteran Education (PAVE): Implementing a Sustainable Peer Support Program for Student Veterans on College Campuses

ERIC Educational Resources Information Center

Kees, Michelle; Risk, Brittany; Meadowbrooke, Chrysta; Nellett, Timothy; Spinner, Jane

2017-01-01

Student veterans have been attending college in greater numbers since the passing of the Post/9-11 GI Bill. Although similar to other nontraditional students, student veterans face unique transition challenges that can affect their pursuit of higher education. Many student veterans could benefit from dedicated programs to help them succeed in…

World of Work Project, Judson Junior High School: Evaluation Report and Attachments.

ERIC Educational Resources Information Center

Gage, Gerald; Walter, Janice

The World of Work program at Judson Junior High School may be used as a whole or in part by others interested in implementing a similar project, taking into consideration the program was designed to meet the needs of a particular population in a particular geographical context. Instructional resources were suggested by the project director and…

Beliefs and Perceptions of DPRK teachers of English towards CLT Instruction and Factors That Influence Program Implementation

ERIC Educational Resources Information Center

Park, Vickie Bin

2012-01-01

Similar to its neighboring countries of China, South Korea, and Japan, the Democratic People's Republic of Korea (DPRK) (also known as North Korea) has made English a compulsory subject for middle school to university level students, and teacher training programs based on the Communicative Language Teaching (CLT) approach have also been…

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting.

PubMed

Ahmed, Sara; Ware, Patrick; Visca, Regina; Bareil, Celine; Chouinard, Maud-Christine; Desforges, Johanne; Finlayson, Roderick; Fortin, Martin; Gauthier, Josée; Grimard, Dominique; Guay, Maryse; Hudon, Catherine; Lalonde, Lyne; Lévesque, Lise; Michaud, Cecile; Provost, Sylvie; Sutton, Tim; Tousignant, Pierre; Travers, Stella; Ware, Mark; Gogovor, Amede

2015-10-15

Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.

Binary Classification using Decision Tree based Genetic Programming and Its Application to Analysis of Bio-mass Data

NASA Astrophysics Data System (ADS)

To, Cuong; Pham, Tuan D.

2010-01-01

In machine learning, pattern recognition may be the most popular task. "Similar" patterns identification is also very important in biology because first, it is useful for prediction of patterns associated with disease, for example cancer tissue (normal or tumor); second, similarity or dissimilarity of the kinetic patterns is used to identify coordinately controlled genes or proteins involved in the same regulatory process. Third, similar genes (proteins) share similar functions. In this paper, we present an algorithm which uses genetic programming to create decision tree for binary classification problem. The application of the algorithm was implemented on five real biological databases. Base on the results of comparisons with well-known methods, we see that the algorithm is outstanding in most of cases.

Floating-Point Units and Algorithms for field-programmable gate arrays

DOE Office of Scientific and Technical Information (OSTI.GOV)

Underwood, Keith D.; Hemmert, K. Scott

2005-11-01

The software that we are attempting to copyright is a package of floating-point unit descriptions and example algorithm implementations using those units for use in FPGAs. The floating point units are best-in-class implementations of add, multiply, divide, and square root floating-point operations. The algorithm implementations are sample (not highly flexible) implementations of FFT, matrix multiply, matrix vector multiply, and dot product. Together, one could think of the collection as an implementation of parts of the BLAS library or something similar to the FFTW packages (without the flexibility) for FPGAs. Results from this work has been published multiple times and wemore » are working on a publication to discuss the techniques we use to implement the floating-point units, For some more background, FPGAS are programmable hardware. "Programs" for this hardware are typically created using a hardware description language (examples include Verilog, VHDL, and JHDL). Our floating-point unit descriptions are written in JHDL, which allows them to include placement constraints that make them highly optimized relative to some other implementations of floating-point units. Many vendors (Nallatech from the UK, SRC Computers in the US) have similar implementations, but our implementations seem to be somewhat higher performance. Our algorithm implementations are written in VHDL and models of the floating-point units are provided in VHDL as well. FPGA "programs" make multiple "calls" (hardware instantiations) to libraries of intellectual property (IP), such as the floating-point unit library described here. These programs are then compiled using a tool called a synthesizer (such as a tool from Synplicity, Inc.). The compiled file is a netlist of gates and flip-flops. This netlist is then mapped to a particular type of FPGA by a mapper and then a place- and-route tool. These tools assign the gates in the netlist to specific locations on the specific type of FPGA chip used and constructs the required routes between them. The result is a "bitstream" that is analogous to a compiled binary. The bitstream is loaded into the FPGA to create a specific hardware configuration.« less

Ontario's emergency department process improvement program: the experience of implementation.

PubMed

Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

2015-06-01

In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the development and implementation of future similar interventions in health care settings could be useful. © 2015 by the Society for Academic Emergency Medicine.

Runtime Verification of C Programs

NASA Technical Reports Server (NTRS)

Havelund, Klaus

2008-01-01

We present in this paper a framework, RMOR, for monitoring the execution of C programs against state machines, expressed in a textual (nongraphical) format in files separate from the program. The state machine language has been inspired by a graphical state machine language RCAT recently developed at the Jet Propulsion Laboratory, as an alternative to using Linear Temporal Logic (LTL) for requirements capture. Transitions between states are labeled with abstract event names and Boolean expressions over such. The abstract events are connected to code fragments using an aspect-oriented pointcut language similar to ASPECTJ's or ASPECTC's pointcut language. The system is implemented in the C analysis and transformation package CIL, and is programmed in OCAML, the implementation language of CIL. The work is closely related to the notion of stateful aspects within aspect-oriented programming, where pointcut languages are extended with temporal assertions over the execution trace.

Concepts for Life Cycle Cost Control Required to Achieve Space Transportation Affordability and Sustainability

NASA Technical Reports Server (NTRS)

Rhodes, Russel E.; Zapata, Edgar; Levack, Daniel J. H.; Robinson, John W.; Donahue, Benjamin B.

2009-01-01

Cost control must be implemented through the establishment of requirements and controlled continually by managing to these requirements. Cost control of the non-recurring side of life cycle cost has traditionally been implemented in both commercial and government programs. The government uses the budget process to implement this control. The commercial approach is to use a similar process of allocating the non-recurring cost to major elements of the program. This type of control generally manages through a work breakdown structure (WBS) by defining the major elements of the program. If the cost control is to be applied across the entire program life cycle cost (LCC), the approach must be addressed very differently. A functional breakdown structure (FBS) is defined and recommended. Use of a FBS provides the visibifity to allow the choice of an integrated solution reducing the cost of providing many different elements of like function. The different functional solutions that drive the hardware logistics, quantity of documentation, operational labor, reliability and maintainability balance, and total integration of the entire system from DDT&E through the life of the program must be fully defined, compared, and final decisions made among these competing solutions. The major drivers of recurring cost have been identified and are presented and discussed. The LCC requirements must be established and flowed down to provide control of LCC. This LCC control will require a structured rigid process similar to the one traditionally used to control weight/performance for space transportation systems throughout the entire program. It has been demonstrated over the last 30 years that without a firm requirement and methodically structured cost control, it is unlikely that affordable and sustainable space transportation system LCC will be achieved.

"Compassion, pleasantry, and hope": a process evaluation of a volunteer-based nonprofit.

PubMed

Mye, Sarah C; Moracco, Kathryn E

2015-06-01

As funders continue to emphasize the importance of documented results, nonprofit organizations must work to complete program evaluations that are both valuable and feasible. The purpose of this paper is to document a practical process evaluation of a southeastern nonprofit, a local Meals on Wheels. Using a mixed methods approach, we sought to answer four evaluation questions: (1) What are the essential program components, as identified by key stakeholders; (2) To what extent are volunteers implementing the identified essential components as intended; (3) What is the level of volunteer satisfaction with the program; and (4) What suggestions do stakeholders have for improving the program? Our findings indicate that most aspects of the program were implemented as intended, but inconsistencies occurred when volunteers were unsure of their assigned duties. In addition, volunteers had high levels of satisfaction and specific suggestions for improvement. From these results, we developed a conceptual model of factors contributing to quality of implementation and volunteer satisfaction that may be generalizable to other volunteer-based nonprofits. Specifically, we identified three factors that helped to facilitate satisfaction and performance: leadership, social contact, and fulfillment. Finally, this process evaluation demonstrates the feasibility of developing and implementing evaluation tools in similar organizations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Estimation of the potential leakage of the chemical munitions based on two hydrodynamical models implemented for the Baltic Sea

NASA Astrophysics Data System (ADS)

Jakacki, Jaromir; Golenko, Mariya

2014-05-01

Two hydrodynamical models (Princeton Ocean Model (POM) and Parallel Ocean Program (POP)) have been implemented for the Baltic Sea area that consists of locations of the dumped chemical munitions during II War World. The models have been configured based on similar data source - bathymetry, initial conditions and external forces were implemented based on identical data. The horizontal resolutions of the models are also very similar. Several simulations with different initial conditions have been done. Comparison and analysis of the bottom currents from both models have been performed. Based on it estimating of the dangerous area and critical time have been done. Also lagrangian particle tracking and passive tracer were implemented and based on these results probability of the appearing dangerous doses and its time evolution have been presented. This work has been performed in the frame of the MODUM project financially supported by NATO.

Development of a Health System-Based Nurse-Delivered Aromatherapy Program.

PubMed

Joswiak, Denise; Kinney, Mary Ellen; Johnson, Jill R; Kolste, Alison K; Griffin, Kristen H; Rivard, Rachael L; Dusek, Jeffery A

2016-04-01

Healthcare systems are increasingly looking to integrate aromatherapy (essential oils) as a safe, low-cost, and nonpharmacologic option for patient care to reduce pain, nausea, and anxiety and to improve sleep. This article describes the development and implementation of a healthcare system-wide program of nurse-delivered essential oil therapeutic interventions to inpatients throughout an acute care setting. In addition, we provide lessons learned for nursing administrators interested in developing similar nurse-delivered aromatherapy programs.

Barriers and facilitators to the implementation of SPNS interventions designed to engage and retain HIV positive women of color in medical care.

PubMed

Garcia, Iliana A; Blank, Arthur E; Eastwood, Elizabeth A; Karasz, Alison

2015-04-01

The use of evidence-based strategies to increase access to medical care and improve health outcomes for people living with HIV is a major public health priority in the United States. As part of a multi-site evaluation funded under the Health Resources and Services Administration (HRSA), a process evaluation was conducted with the goal of understanding barriers and facilitators to the implementation of eleven heterogeneous interventions designed to engage and retain HIV positive women of color (WoC) in medical care. Findings identified barriers and facilitators to program implementation at five levels: (1) program; (2) team; (3) agency; (4) partner network; and (5) the larger socio-ecological context. We conclude with a series of recommendations that may be useful for the implementation of similar interventions focused on recruitment and retention of WoC in HIV medical care.

[Managing concerns about falls in older people: evaluation of the implementation of an evidence-based program].

PubMed

Zijlstra, G A R; Du Moulin, M F M T; van Haastregt, J C M; de Jonge, M; Kempen, G I J M; van der Poel, A

2013-12-01

A cognitive behavioral program reduced concerns about falling and related avoidance behavior among older community-dwelling adults in a randomized controlled trial. In the current study we examined the effects and acceptability of the program after nation-wide implementation into home care organizations in The Netherlands. In a one-group pretest-posttest study with data collection before the start of the program and at 2 and 4 months, the effects and acceptability of the program were assessed in 125 community-dwelling older people. The outcomes of the effect evaluation included concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of anxiety, symptoms of depression, and loneliness. Pretest-posttest analyses with the Wilcoxon signed-rank test and the paired t-test showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for the other outcomes. After implementation in home care organizations, the outcomes indicate positive program effects on concerns about falls, avoidance behavior, and falls in community-dwelling older people. Given the similarity in results, i.e. between those of the previously performed randomized controlled trial and those of the current pretest-posttest study, we conclude that the program can be successfully implemented in practice. This article is an adjusted, Dutch version of Zijlstra GA, van Haastregt JC, Du Moulin MF, de Jonge MC, van der Poel A, Kempen GI. Effects of the implementation of an evidenc-based program to manage concerns about falls in older adults. The Gerontologist 2013;53(5):839-849; doi: 10.1093/geront/gns142.

Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh.

PubMed

Adams, Alayne; Sedalia, Saroj; McNab, Shanon; Sarker, Malabika

2016-03-01

Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Results of the Association of Directors of Radiation Oncology Programs (ADROP) Survey of Radiation Oncology Residency Program Directors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harris, Eleanor; Abdel-Wahab, May; Spangler, Ann E.

2009-06-01

Purpose: To survey the radiation oncology residency program directors on the topics of departmental and institutional support systems, residency program structure, Accreditation Council for Graduate Medical Education (ACGME) requirements, and challenges as program director. Methods: A survey was developed and distributed by the leadership of the Association of Directors of Radiation Oncology Programs to all radiation oncology program directors. Summary statistics, medians, and ranges were collated from responses. Results: Radiation oncology program directors had implemented all current required aspects of the ACGME Outcome Project into their training curriculum. Didactic curricula were similar across programs nationally, but research requirements and resourcesmore » varied widely. Program directors responded that implementation of the ACGME Outcome Project and the external review process were among their greatest challenges. Protected time was the top priority for program directors. Conclusions: The Association of Directors of Radiation Oncology Programs recommends that all radiation oncology program directors have protected time and an administrative stipend to support their important administrative and educational role. Departments and institutions should provide adequate and equitable resources to the program directors and residents to meet increasingly demanding training program requirements.« less

Implementing Multisector Nutrition Programs in Ethiopia and Nepal: Challenges and Opportunities From a Stakeholder Perspective.

PubMed

Kennedy, Eileen; Fekadu, Habtamu; Ghosh, Shibani; Baral, Kedar; Davis, Dale; Sapkota, Diplav; Webb, Patrick

2016-12-01

Effective governance is essential for effective nutrition program implementation. There are additional challenges in launching multisector plans to enhance nutritional status. The present study compares the challenges and opportunities in Ethiopia and Nepal in designing and implementing a multisector plan for nutrition. A semi-quantitative questionnaire with open-ended questions was used to solicit information from senior national-level policy officials and other key stakeholders. The nature of the major nutrition problems in each country was similar; these include malnutrition (particularly stunting), food insecurity, and micronutrient malnutrition. The main challenges identified included the need for more specificity in the roles of agencies/individuals in program implementation, more effective mechanisms for linking national to subnational officials, methods for creating awareness of the plans, and a dedicated line item in the budgets of each agency. The level of enthusiasm was high in both countries. Respondents in both countries highlighted the need to identify a "champion" at the highest level who would keep the momentum for the respective plans alive. © The Author(s) 2016.

The Benefits and Costs of National Service: Methods for Benefit Assessment with Application to Three AmeriCorps Programs.

ERIC Educational Resources Information Center

Neumann, George R.; And Others

A study applied the principles of benefit-cost analysis to three prototype grants programs of AmeriCorps: AmeriCorps for Math and Literacy, Project First, and the East Bay Conservation Corps. It studied the methods these projects used and estimated the benefits using data from projects similar in approach and implementation. Benefits received by…

Paediatric patient navigation models of care in Canada: An environmental scan.

PubMed

Luke, Alison; Doucet, Shelley; Azar, Rima

2018-05-01

(1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.

A qualitative analysis of the concepts of fidelity and adaptation in the implementation of an evidence-based HIV prevention intervention.

PubMed

Owczarzak, Jill; Broaddus, Michelle; Pinkerton, Steven

2016-04-01

Continued debate about the relative value of fidelity versus adaptation, and lack of clarity about the meaning of fidelity, raise concerns about how frontline service providers resolve similar issues in their daily practice. We use SISTA ('Sisters Informing Sisters on Topics about acquired immune deficiency syndrome'), an evidence-based human immunodeficiency virus (HIV) prevention intervention for African American women, to understand how facilitators and program directors interpret and enact implementation fidelity with the need for adaptation in real-world program delivery. We conducted 22 in-depth, semi-structured interviews with service providers from four agencies implementing SISTA. Facilitators valued their skills as group leaders and ability to emotionally engage participants as more critical to program effectiveness than delivering the intervention with strict fidelity. Consequently, they saw program manuals as guides rather than static texts that should never be changed and, moreover, viewed the prescriptive nature of manuals as undermining their efforts to fully engage with participants. Our findings suggest that greater consideration should be given to understanding the role of facilitators in program effectiveness over and above the question of whether they implement the program with fidelity. Moreover, training curricula should provide facilitators with transferable skills through general facilitator training rather than only program-specific or manual-specific training. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Implementation of a volunteer university student research assistant program in an emergency department: the nuts and bolts for success.

PubMed

Steadman, Patrick E; Crudden, Johanna; Boutis, Kathy

2015-09-01

Prospective research studies often advance clinical practice in the emergency department (ED), but they can be costly and difficult to perform. In this report, we describe the implementation of a volunteer university student research assistant program that provides students exposure to medicine and clinical research while simultaneously increasing the capacity of an ED's research program. This type of program provides 15 hours per day of research assistant coverage for patient screening and enrolment for minimal risk research studies, and screening for higher risk studies. The latter is true without the added burden or costs of co-administering university course credit or pay for service, which are common features of most of these types of programs currently in operation. We have shown that our volunteer-based program is effective for an ED's research success as well as for its student participants. For other EDs interested in adopting similar programs, we provide the details on how to get such a program started and highlight the structure and non-monetary incentives that facilitate a program's ongoing success.

Fall in genital warts diagnoses in the general and indigenous Australian population following implementation of a national human papillomavirus vaccination program: analysis of routinely collected national hospital data.

PubMed

Smith, Megan A; Liu, Bette; McIntyre, Peter; Menzies, Robert; Dey, Aditi; Canfell, Karen

2015-01-01

Human papillomavirus (HPV) vaccination targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of females aged 13-26 years continuing to 2009. Whole-population analyses, including effects on the Indigenous population, have not previously been reported. All hospital admissions between 1999-2011 involving a diagnosis of genital warts were obtained from a comprehensive national database. We compared the age-specific rates before to those after implementation of the vaccination program, according to sex and other characteristics. Admission rates decreased from mid-2007 in females aged 12-17 years (annual decline, 44.1% [95% confidence interval {CI}, 35.4%-51.6%]) and from mid-2008 in females and males aged 18-26 years (annual declines, 31.8% [95% CI, 28.4%-35.2%] and 14.0% [95% CI, 5.1%-22.1%], respectively). The overall reductions from 2006-2007 to 2010-2011 were 89.9% (95% CI, 84.4%-93.4%) for females aged 12-17 years, 72.7% (95% CI, 67.0%-77.5%) for females aged 18-26 years, and 38.3% (95% CI, 27.7%-47.2%) for males aged 18-26 years. Compared with the average annual number before program implementation, about 1000 fewer hospital admissions involved a warts diagnosis during 2010-2011. Reductions after program implementation were similar for Indigenous (86.7% [95% CI, 76.0-92.7]) and non-Indigenous (76.1% [95% CI, 71.6%-79.9%]) females aged 15-24 years (P(heterogeneity) = .08). National population-based hospital data confirm previous clinic-based reports of a marked decline in genital warts diagnoses among young people in Australia after program implementation, including indirect benefits to males. The impact of HPV vaccination appears to be similar in young Indigenous and non-Indigenous females. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

REACH VA: Moving from Translation to System Implementation.

PubMed

Nichols, Linda O; Martindale-Adams, Jennifer; Burns, Robert; Zuber, Jeffrey; Graney, Marshall J

2016-02-01

Resources for Enhancing All Caregivers Health in the Department of Veterans Affairs (REACH VA) has been implemented in the VA system as a national program for caregivers. We describe the trajectory of REACH VA from national randomized clinical trial through translation to national implementation. The implementation is examined through the six stages of the Fixsen and Blasé implementation process model: exploration and adoption, program installation, initial implementation, full operation, innovation, and sustainability. Different drivers that move the implementation process forward are important at each stage, including staff selection, staff training, consultation and coaching, staff evaluation, administrative support, program evaluation/fidelity, and systems interventions. Caregivers in the REACH VA 4 session intervention currently implemented in the VA had similar outcomes to longer REACH interventions, including Resources for Enhancing Alzheimer's Caregivers Health (REACH II). Caregivers experienced significant decreases in burden, depression, anxiety, number of troubling patient behaviors reported, caregiving frustrations, stress symptoms (feeling overwhelmed, feeling like crying, being frustrated as a result of caregiving, being lonely), and general stress. Effect sizes (Cohen's d) for these significant variables were between small and medium ranging from .24 to .46. The implementation of REACH VA provides a road map for implementation of other behavioral interventions in health care delivery settings. Lessons learned include the importance of implementing a proven, needed intervention, support from both leadership and clinical staff, willingness to respond to staff and organization needs and modify the intervention while preserving its integrity, and fitting the intervention into ongoing routines and practices. Published by Oxford University Press on behalf of the Gerontological Society of America 2014.

A Preventive Intervention Program for Urban African American Youth Attending an Alternative Education Program: Background, Implementation, and Feasibility.

PubMed

Carswell, Steven B; Hanlon, Thomas E; O'Grady, Kevin E; Watts, Amy M; Pothong, Pattarapan

2009-01-01

This paper presents background, implementation, and feasibility findings associated with planning and conducting an after-school intervention program in an alternative education setting designed to prevent the initiation and escalation of violence and substance abuse among urban African American youth at high risk for life-long problem behaviors. Evolving from earlier preventive interventions implemented in clinic and school settings, the program, entitled The Village Model of Care, consisted of structured group mentoring, parental support, and community outreach services administered to alternative education students and their primary caregiver(s) during the school year. Over a two-year intake period, 109 youth participated in the present process evaluation study. Findings from the study not only provided relevant demographic information on the characteristics of youth likely to be included in such programs but also indicated the importance of including the family in the rehabilitation effort and the need for school administrative system support for the underlying alternative education approach. The information presented in this report has a direct bearing on the planning of future prevention efforts conducted in similar settings that are aimed at reducing problem behaviors and promoting positive lifestyles among high-risk youth.

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults.

PubMed

Goedendorp, Martine M; Kuiper, Daphne; Reijneveld, Sijmen A; Sanderman, Robbert; Steverink, Nardi

2017-06-01

The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity. In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity. No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations. The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity. The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

Scalable Unix commands for parallel processors : a high-performance implementation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ong, E.; Lusk, E.; Gropp, W.

2001-06-22

We describe a family of MPI applications we call the Parallel Unix Commands. These commands are natural parallel versions of common Unix user commands such as ls, ps, and find, together with a few similar commands particular to the parallel environment. We describe the design and implementation of these programs and present some performance results on a 256-node Linux cluster. The Parallel Unix Commands are open source and freely available.

OpenARC: Extensible OpenACC Compiler Framework for Directive-Based Accelerator Programming Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Seyong; Vetter, Jeffrey S

2014-01-01

Directive-based, accelerator programming models such as OpenACC have arisen as an alternative solution to program emerging Scalable Heterogeneous Computing (SHC) platforms. However, the increased complexity in the SHC systems incurs several challenges in terms of portability and productivity. This paper presents an open-sourced OpenACC compiler, called OpenARC, which serves as an extensible research framework to address those issues in the directive-based accelerator programming. This paper explains important design strategies and key compiler transformation techniques needed to implement the reference OpenACC compiler. Moreover, this paper demonstrates the efficacy of OpenARC as a research framework for directive-based programming study, by proposing andmore » implementing OpenACC extensions in the OpenARC framework to 1) support hybrid programming of the unified memory and separate memory and 2) exploit architecture-specific features in an abstract manner. Porting thirteen standard OpenACC programs and three extended OpenACC programs to CUDA GPUs shows that OpenARC performs similarly to a commercial OpenACC compiler, while it serves as a high-level research framework.« less

Facilitators and Hindrances of Implementing Colorectal Cancer Screening Intervention Among Vietnamese Americans.

PubMed

Sin, Mo-Kyung; Yip, Mei-Po; Kimura, Amanda; Tu, Shin-Ping

Little is published about the factors that facilitate and hinder the intervention implementation process. The aim of this study was to examine factors that facilitated and hindered the implementation of a culturally appropriate colorectal cancer screening intervention targeting Vietnamese Americans in a Federally Qualified Health Center located in the Puget Sound area of Washington. Three focus group discussions (2 during the implementation phase and 1 during the maintenance phase) with the medical assistants (N = 13) who were the intervention implementation agents were conducted at the Federally Qualified Health Center. Three research team members independently analyzed the data using content analysis and then compared for agreement. We reread and recoded the transcripts until consensus was reached. The themes were clustered by similar codes and categorized into 4 groups, each including facilitators and hindrances of implementation: identification of implementation agents, implementation environment, intervention recipients, and the colorectal cancer screening intervention. Facilitators included medical assistants' high motivation with a positive attitude toward the intervention, team approach, and simplicity of the intervention, whereas hindrances included lack of time, forgetfulness, staff turnover, and language barriers. The findings emphasized the importance of supporting implementation agents to ensure effective intervention program implementation. Oncology nurses need to particularly take into consideration the evidence-based findings when planning any intervention programs.

Coordination as a best practice from the polio eradication initiative: Experiences from five member states in the African region of the World Health Organization.

PubMed

Okeibunor, Joseph; Nsubuga, Peter; Salla, Mbaye; Mihigo, Richard; Mkanda, Pascal

2016-10-10

As part of the efforts to eradicate polioviruses in the African Region, structures were put in place to ensure coordinated mobilization and deployment of resources within the framework of the global polio eradication initiative (PEI). The successes of these structures made them not only attractive to other public health interventions, but also caused them to be deployed to the response efforts of other diseases interventions, without any systematic documentation. This article documents the contributions of PEI coordination units to other public health interventions in the African Region of World Health Organization METHODS: We reviewed the contributions of PEI coordination units to other public health interventions in five countries in the African Region. The analysis identified significant involvement of PEI coordination structures in the implementation of routine immunization programs in all the countries analyzed. Similarly, maternal and child health programs were planned, implemented, monitored and evaluation the Inter-Agency Coordination Committees of the PEI programs in the different countries. The hubs system used in PEI in Chad facilitated the efficient coordination of resources for immunization and other public health interventions in Chad. Similarly, in the Democratic Republic of Congo PEI led coordination activities benefited other public health programs like disease control and the national nutrition program, the national malaria control program, and the tuberculosis control program. In Nigeria, the polio Expert Review Committee effectively deployed the Emergency Operation Center for the implementation of prioritized strategies and activities of the National Polio Eradication Emergency Plan, and it was utilized in the response to Ebola Virus Disease outbreak in the country. The PEI-led coordination systems are thus recognized as having made significant contribution to the coordination and delivery of other public health interventions in the African Region. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Superfund Reform 1995. Principles for a new Superfund program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bresnick, W.

1995-11-01

Superfund Reform `95 is a broad coalition of small and large businesses and local governments. Superfund Reform `95 believes now is the time for a new law to be drafted based on the principles and programmatic elements described below. Superfund Reform `95 believes that the program they are proposing will generate efficiencies and cost savings that will permit it to be implemented without the need to increase the total amount of taxes currently being levied to support the Superfund. The current federal Superfund program is badly broken and in need of major restructuring. The existing Superfund program must be replacedmore » by a new program in which the benefits justify its cost and which is equitable, cost-effective, and limited in size and scope so that it is targeted to address real, current, and significant risks to human health and environment posed by the past disposal of hazardous substances. The size of the federal National Priorities List (NPL) should be capped so that the remedial response program is phased out over time. Retroactive liability should be repealed and the remedy selection process significantly reformed. States should be given the opportunity to be delegated implementation of the reformed federal Superfund program at NPL sites as well as provided with incentives to implement their own similarly reformed programs in a fair and cost-effective manner.« less

A Hybrid Effectiveness-Implementation Trial of an Evidence-Based Exercise Intervention for Breast Cancer Survivors

PubMed Central

Beidas, Rinad S.; Paciotti, Breah; Barg, Fran; Branas, Andrea R.; Brown, Justin C.; Glanz, Karen; DeMichele, Angela; DiGiovanni, Laura; Salvatore, Domenick

2014-01-01

Background The primary aims of this hybrid Type 1 effectiveness-implementation trial were to quantitatively assess whether an evidence-based exercise intervention for breast cancer survivors, Strength After Breast Cancer, was safe and effective in a new setting and to qualitatively assess barriers to implementation. Methods A cohort of 84 survivors completed measurements related to limb volume, muscle strength, and body image at baseline, 67 survivors completed measurements 12 months later. Qualitative methods were used to understand barriers to implementation experienced by referring oncology clinicians and physical therapists who delivered the program. Results Similar to the efficacy trial, the revised intervention demonstrated safety with regard to lymphedema, and led to improvements in lymphedema symptoms, muscular strength, and body image. Comparison of effects in the effectiveness trial to effects in the efficacy trial revealed larger strength increases in the efficacy trial than in the effectiveness trial (P < .04), but few other differences were found. Qualitative implementation data suggested significant barriers around intervention characteristics, payment, eligibility criteria, the referral process, the need for champions (ie, advocates), and the need to adapt during implementation of the intervention, which should be considered in future dissemination and implementation efforts. Conclusions This trial successfully demonstrated that a physical therapy led strength training program for breast cancer survivors can be implemented in a community setting while retaining the effectiveness and safety of the clinical trial. However, during the translation process, strategies to reduce barriers to implementation are required. This new program can inform larger scale dissemination and implementation efforts. PMID:25749601

A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya.

PubMed

Abuya, Timothy; Njuki, Rebecca; Warren, Charlotte E; Okal, Jerry; Obare, Francis; Kanya, Lucy; Askew, Ian; Bellows, Ben

2012-07-23

Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.

Challenges to implementing Gavi's health system strengthening support in Chad and Cameroon: results from a mixed-methods evaluation.

PubMed

Dansereau, Emily; Miangotar, Yodé; Squires, Ellen; Mimche, Honoré; El Bcheraoui, Charbel

2017-11-16

Since 2005, Gavi has provided health system strengthening (HSS) grants to address bottlenecks affecting immunization services. This study is the first to evaluate the Gavi HSS implementation process in either Cameroon or Chad, two countries with significant health system challenges and poor achievement on the child and maternal health Millennium Development Goals. We triangulated quantitative and qualitative data including financial records, document review, field visit questionnaires, and key informant interviews (KII) with representatives from the Ministries of Health, Gavi, and other partners. We conducted a Root Cause Analysis of key implementation challenges, guided by the Consolidated Framework for Implementation Research. We conducted 124 field visits and 43 KIIs in Cameroon, and 57 field visits and 39 KIIs in Chad. Cameroon's and Chad's HSS programs were characterized by delayed disbursements, significant deviations from approved expenditures, and reprogramming of funds. Nearly a year after the programs were intended to be complete, many district and facility-level activities were only partially implemented and significant funds remained unabsorbed. Root causes of these challenges included unpredictable Gavi processes and disbursements, poor communication between the countries and Gavi, insufficient country planning without adequate technical assistance, lack of country staff and leadership, and weak country systems to manage finances and promote institutional memory. Though Chad and Cameroon both critically needed support to strengthen their weak health systems, serious challenges drastically limited implementation of their Gavi HSS programs. Implementation of future HSS programs in these and similar settings can be improved by transparent and reliable procedures and communication from Gavi, proposals that account for countries' programmatic capacity and the potential for delayed disbursements, implementation practices that foster learning and adaptation, and an early emphasis on developing managerial and other human resources.

A Policy Analysis of the implementation of a Reproductive Health Vouchers Program in Kenya

PubMed Central

2012-01-01

Background Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. Methods Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. Results The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. Conclusions OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government’s role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies. PMID:22823923

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers.

PubMed

Velasco, Veronica; Griffin, Kenneth W; Antichi, Mariella; Celata, Corrado

2015-10-01

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort. Copyright © 2015 Elsevier Ltd. All rights reserved.

Career Techniques and Interventions: Themes from an International Conversation

ERIC Educational Resources Information Center

Feller, Rich W.; Russell, Martha; Whichard, Judy A.

2005-01-01

The need for appropriate, timely, and increasingly comprehensive career development and education programs continues to escalate. It is interesting that despite the differences in cultures, religions, economies, political systems, and education structures, many countries face similar challenges when designing and implementing career development…

Conducting a Hiring Fair Simulation for Teacher Education Candidates

ERIC Educational Resources Information Center

Mosier, Brian; Heidorn, Brent; Johnson, Christie

2015-01-01

The purpose of this article is to provide a basic review of a hiring simulation fair, and to describe strategies for successfully implementing a similar organized event in a college/university teacher education program in order to better prepare students for the interview process.

76 FR 35219 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-16

... service environment in which the evaluation is implemented and the opportunities for control group members to access the same or similar services as the treatment group members. Respondents: Individuals enrolled in ISIS demonstration interventions, control group members, ISIS program operators (BIF and SAQ...

77 FR 34953 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

... needs assessment similar to the assessment required for all States under the legislation and (2... 5-year cooperative agreements to conduct community needs assessments, plan for and implement (in... Childhood Home Visiting Program Guidance for Submitting a Needs Assessment and Plan for Responding to...

Implementation Costs of an Enhanced Recovery After Surgery Program in the United States: A Financial Model and Sensitivity Analysis Based on Experiences at a Quaternary Academic Medical Center.

PubMed

Stone, Alexander B; Grant, Michael C; Pio Roda, Claro; Hobson, Deborah; Pawlik, Timothy; Wu, Christopher L; Wick, Elizabeth C

2016-03-01

Despite positive results from several international Enhanced Recovery After Surgery (ERAS) protocols, the United States has been slow to adopt ERAS protocols, in part due to concern regarding the expenses of such a program. We sought to evaluate the potential annual net cost savings of implementing a US-based ERAS program. Using data from existing publications and experience with an ERAS program, a model of net financial costs was developed for surgical groups of escalating numbers of annual cases. Our example scenario provided a financial analysis of the implementation of an ERAS program at a United States academic institution based on data from the ERAS Program for Colorectal Surgery at The Johns Hopkins Hospital. Based on available data from the United States, ERAS programs lead to reductions in lengths of hospital stay that range from 0.7 to 2.7 days and substantial direct cost savings. Using example data from a quaternary hospital, the considerable cost of $552,783 associated with implementation of an ERAS program was offset by even greater savings in the first year of nearly $948,500, yielding a net savings of $395,717. Sensitivity analysis across several caseload and direct cost scenarios yielded similar savings in 20 of the 27 projections. Enhanced Recovery After Surgery protocols have repeatedly led to reduction in length of hospital stay and improved surgical outcomes. A financial model, based on published data and experience, projects that investment in an ERAS program can also lead to net financial savings for US hospitals. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of Implementing Antibiotic Stewardship Programs in 15 Small Hospitals: A Cluster-Randomized Intervention.

PubMed

Stenehjem, Edward; Hersh, Adam L; Buckel, Whitney R; Jones, Peter; Sheng, Xiaoming; Evans, R Scott; Burke, John P; Lopansri, Bert K; Srivastava, Rajendu; Greene, Tom; Pavia, Andrew T

2018-02-23

Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs. The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models. Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant. Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline. NCT03245879.

Implementation of the O(αt2) MSSM Higgs-mass corrections in FeynHiggs

NASA Astrophysics Data System (ADS)

Hahn, Thomas; Paßehr, Sebastian

2017-05-01

We describe the implementation of the two-loop Higgs-mass corrections of O(αt2) in the complex MSSM in FeynHiggs. The program for the calculation is comprised of several scripts which flexibly use FeynArts and FormCalc together with other packages. It is included in FeynHiggs and documented here in some detail so that it can be re-used as a template for similar calculations.

WIS Implementation Study Report. Volume 3. Background Information.

DTIC Science & Technology

1983-10-01

similar representations so that a single schema interpreter can serve in either environment. Examples of schema intepreters exist in all databases...Unfortunately, programs expect ing ;L VSA M file caninot accept a similar, non-VSAM file instead. In practice, a tile written using any of tire 6 film ...Thomas Kaczmarek USC/Information Sciences Institute 4676 Admiralty Way Marina del Rey, CA 90292 14 September 1983 247 PAiIECDIG PAMI &~A -NOT FILM

Changing organization culture: data driven participatory evaluation and revision of wraparound implementation.

PubMed

Bertram, Rosalyn M; Schaffer, Pam; Charnin, Leia

2014-01-01

Family members and professionals in a Substance Abuse and Mental Health Services Administration Children's Mental Health Systems of Care Initiative in Houston, Texas conducted a participatory evaluation to examine wraparound implementation. Results guided systematic, theory-based program revisions. By focusing through empirically derived frameworks for implementation, the evaluation team identified and generated useful data sources to support and improve wraparound provision. Despite working with a more diverse population in which youth displayed more severe behaviors than in similar grants, after 18 months more families received service and outcomes improved as fidelity scores advanced above the national mean.

Conditioning of high voltage radio frequency cavities by using fuzzy logic in connection with rule based programming

NASA Astrophysics Data System (ADS)

Perreard, S.; Wildner, E.

1994-12-01

Many processes are controlled by experts using some kind of mental model to decide on actions and make conclusions. This model, based on heuristic knowledge, can often be represented by rules and does not have to be particularly accurate. Such is the case for the problem of conditioning high voltage RF cavities; the expert has to decide, by observing some criteria, whether to increase or to decrease the voltage and by how much. A program has been implemented which can be applied to a class of similar problems. The kernel of the program is a small rule base, which is independent of the kind of cavity. To model a specific cavity, we use fuzzy logic which is implemented as a separate routine called by the rule base, to translate from numeric to symbolic information.

77 FR 34129 - Heavy-Duty Highway Program: Revisions for Emergency Vehicles

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-08

... diesel vehicles, including emergency vehicles. Some control system designs and implementation strategies... broad engine families and vehicle test groups that are defined by similar emissions and performance... public safety issue related to design of engines and emission control systems on emergency vehicles that...

“Because we all trust and care about each other”: Exploring Tensions Translating a Theater-based HIV Prevention Intervention into a New Context

PubMed Central

Mouw, Mary Sherwyn; Taboada, Arianna; Steinert, Scarlett; Willis, Stephanie; Lightfoot, Alexandra F.

2016-01-01

Background A theater-based HIV prevention intervention developed in urban California was piloted with a new partnership in North Carolina. Objectives To describe the experience of translating a complex program with an enhanced partnership approach; barriers and facilitators of implementation in the new setting; and challenges and benefits of interdisciplinary, collaborative interventions. Methods We gathered perspectives of local stakeholders involved in program implementation through process evaluation interviews and focus groups with undergraduates, a college instructor, school district administrators, and high school teachers. Results Implementing the intervention in a new setting proved feasible and successful; however, mistaken assumptions and unrecognized similarities about teaching priorities, philosophies, and values produced latent tensions amongst stakeholder groups, and were a limiting factor in partnership functioning. Conclusions Implementing a cross-disciplinary intervention in a new setting is best achieved through a local community-engaged process, with active involvement of relevant stakeholders. We suggest strategies to strengthen community partnerships cooperating in implementation of complex, context-tailored interventions. PMID:27346770

Implementation of a Regional Training Program on African Swine Fever As Part of the Cooperative Biological Engagement Program across the Caucasus Region

PubMed Central

De Nardi, Marco; Léger, Anaïs; Stepanyan, Tatul; Khachatryan, Bagrat; Karibayev, Talgat; Sytnik, Igor; Tyulegenov, Samat; Akhmetova, Assel; Nychyk, Serhiy; Sytiuk, Mykola; Nevolko, Oleg; Datsenko, Roman; Chaligava, Tengiz; Avaliani, Lasha; Parkadze, Otar; Ninidze, Lena; Kartskhia, Natia; Napetvaridze, Tsira; Asanishvili, Zviad; Khelaia, Demna; Menteshashvili, Ioseb; Zadayan, Meruzhan; Niazyan, Lyudmila; Mykhaylovska, Nataliya; Brooks, Bradford Raymond; Zhumabayeva, Gulnara; Satabayeva, Saltanat; Metreveli, Magda; Gallagher, Theresa; Obiso, Richard

2017-01-01

A training and outreach program to increase public awareness of African swine fever (ASF) was implemented by Defense Threat Reduction Agency and the Ministries of Agriculture in Armenia, Georgia, Kazakhstan, and Ukraine. The implementing agency was the company SAFOSO (Switzerland). Integration of this regional effort was administered by subject matter experts for each country. The main teaching effort of this project was to develop a comprehensive regional public outreach campaign through a network of expertise and knowledge for the control and prevention of ASF in four neighboring countries that experience similar issues with this disease. Gaps in disease knowledge, legislation, and outbreak preparedness in each country were all addressed. Because ASF is a pathogen with bioterrorism potential and of great veterinary health importance that is responsible for major economic instability, the project team developed public outreach programs to train veterinarians in the partner countries to accurately and rapidly identify ASF activity and report it to international veterinary health agencies. The project implementers facilitated four regional meetings to develop this outreach program, which was later disseminated in each partner country. Partner country participants were trained as trainers to implement the outreach program in their respective countries. In this paper, we describe the development, execution, and evaluation of the ASF training and outreach program that reached more than 13,000 veterinarians, farmers, and hunters in the partner countries. Additionally, more than 120,000 booklets, flyers, leaflets, guidelines, and posters were distributed during the outreach campaign. Pre- and post-ASF knowledge exams were developed. The overall success of the project was demonstrated in that the principles of developing and conducting a public outreach program were established, and these foundational teachings can be applied within a single country or expanded regionally to disseminate disease information across borders; overall, this method can be modified to raise awareness about many other diseases. PMID:29124058

Ciclovía initiatives: engaging communities, partners, and policy makers along the route to success.

PubMed

Zieff, Susan G; Hipp, J Aaron; Eyler, Amy A; Kim, Mi-Sook

2013-01-01

Recent efforts to increase physical activity through changes to the built environment have led to strategies and programs that use existing public space, including bicycle lanes, temporary parks, and the ciclovia initiative (scheduled events in which streets are closed to motorized vehicles and opened for recreational activities) popularized in South America. This article describes and compares the processes and structures involved in developing and implementing a ciclovia-type program in 2 US urban contexts: San Francisco, California, and St Louis, Missouri. Considering the current growth of and interest in ciclovia initiatives, important outcomes, lessons learned are offered for application in other, similar settings. Primary sources from both initiatives and from published research on ciclovias constitute the body of evidence and include year-end reports, grant applications, meeting minutes, budgets, published ciclovia guidelines, evaluation studies and Web sites, media sources, and interviews and personal communication with the organizers. Primary source documents were reviewed and included in this analysis if they offered information on 3 grounded questions: What processes were used in developing the initiative? What are the current structures and practices used in implementation of initiatives? What are important lessons learned and best practices from initiatives for recommendations to stakeholders and policy makers in other contexts? Among the categories compared, the structures and processes for implementation regarding buy-in and city department collaboration, route selection, programming, partnerships, media promotion, community outreach, and merchant support were relatively similar among the 2 initiatives. The categories that differed included staffing and volunteer engagement and funding. Buy-in from community partners, merchants, residents, and city agencies is critical for a positive experience in developing and implementing ciclovia-type initiatives in urban environments. When funding and staffing are inconsistent or limited, the quality and sustainability of the initiative is less certain.

Use of the national surgical quality improvement program to reduce surgical mortality: implementation of intensive preoperative screening and intervention.

PubMed

Konstantinidis, Agathoklis; Fogel, Sandy; Jones, James; Gilliam, Brenda; Kundzins, John; Baker, Christopher

2014-09-01

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) data at our institution indicated that surgical mortality was significantly higher than expected. This study examines the effect of implementation of a strict, intensive preoperative screening and intervention process on postoperative mortality at our institution, as measured by the NSQIP. Carilion Roanoke Memorial Hospital (CRMH) is a 763-bed tertiary care hospital serving a population of one million people in southwest Virginia. Data were collected for NSQIP at CRMH from July 2007 to December 2012. In January 2010, a new preoperative process was implemented to include risk assessment and intervention for hypertension, cardiac disease, pulmonary disease, diabetes, renal disease, and obstructive sleep apnea. Before initiation of our preoperative program (July 2007 to January 2010), odds ratios (ORs) for 30-day mortality in general and vascular cases were significantly higher than expected (1.40, 1.43, 1.58, and 1.56 in successive reporting periods). Beginning with the first report after implementation of the preoperative screening program, CRMH showed a progressively decreasing OR for overall 30-day mortality (1.26, 1.19, 1.14, 0.86, 0.82, 0.84, 0.89) with similar reductions in both general (0.92) and vascular (0.92) surgery. The implementation of an intensive preoperative screening and intervention process in our institution was accompanied by a significant decrease in the 30-day mortality for general surgery and vascular procedures, as measured by the NSQIP.

Realistic evaluation of an emergency department-based mental health nurse practitioner outpatient service in Australia.

PubMed

Wand, Timothy; White, Kathryn; Patching, Joanna

2011-06-01

Evaluation of new models of care requires consideration of the complexity inherent within health care programs and their sensitivity to local contextual factors as well as broader community, social and political influences. Evaluation frameworks that are flexible and responsive while maintaining research rigor are therefore required. Realistic evaluation was adopted as the methodology for the implementation and evaluation of an emergency department-based mental health nurse practitioner outpatient service in Sydney, Australia. The aim of realistic evaluation is to generate, test and refine theories of how programs work within a given context. This paper represents the final methodological step from the completed evaluation. A summary of quantitative and qualitative findings from the mixed-methods evaluation is presented, which is transformed into a set of overarching statements or "middle range theories". Middle range theory statements seek to explain the success of a program and provide transferable lessons for practitioners wishing to implement similar programs elsewhere. For example, the research team consider that early consultation with key local stakeholders and emergency department ownership of the project was pivotal to the implementation process. © 2011 Blackwell Publishing Asia Pty Ltd.

Sector and Sphere: the design and implementation of a high-performance data cloud

PubMed Central

Gu, Yunhong; Grossman, Robert L.

2009-01-01

Cloud computing has demonstrated that processing very large datasets over commodity clusters can be done simply, given the right programming model and infrastructure. In this paper, we describe the design and implementation of the Sector storage cloud and the Sphere compute cloud. By contrast with the existing storage and compute clouds, Sector can manage data not only within a data centre, but also across geographically distributed data centres. Similarly, the Sphere compute cloud supports user-defined functions (UDFs) over data both within and across data centres. As a special case, MapReduce-style programming can be implemented in Sphere by using a Map UDF followed by a Reduce UDF. We describe some experimental studies comparing Sector/Sphere and Hadoop using the Terasort benchmark. In these studies, Sector is approximately twice as fast as Hadoop. Sector/Sphere is open source. PMID:19451100

Performance and prospects of payments for ecosystem services programs: evidence from China.

PubMed

Yang, Wu; Liu, Wei; Viña, Andrés; Luo, Junyan; He, Guangming; Ouyang, Zhiyun; Zhang, Hemin; Liu, Jianguo

2013-09-30

Systematic evaluation of the environmental and socioeconomic effects of Payments for Ecosystem Services (PES) programs is crucial for guiding policy design and implementation. We evaluated the performance of the Natural Forest Conservation Program (NFCP), a national PES program of China, in the Wolong Nature Reserve for giant pandas. The environmental effects of the NFCP were evaluated through a historical trend (1965-2001) analysis of forest cover to estimate a counter-factual (i.e., without-PES) forest cover baseline for 2007. The socioeconomic effects of the NFCP were evaluated using data collected through household interviews carried out before and after NFCP implementation in 2001. Our results suggest that the NFCP was not only significantly associated with increases in forest cover, but also had both positive (e.g., labor reduction for fuelwood collection) and negative (e.g., economic losses due to crop raiding by wildlife) effects on local households. Results from this study emphasize the importance of integrating local conditions and understanding underlying mechanisms to enhance the performance of PES programs. Our findings are useful for the design and implementation of successful conservation policies not only in our study area but also in similar places around the world. Copyright © 2013 Elsevier Ltd. All rights reserved.

Directly executable formal models of middleware for MANET and Cloud Networking and Computing

NASA Astrophysics Data System (ADS)

Pashchenko, D. V.; Sadeq Jaafar, Mustafa; Zinkin, S. A.; Trokoz, D. A.; Pashchenko, T. U.; Sinev, M. P.

2016-04-01

The article considers some “directly executable” formal models that are suitable for the specification of computing and networking in the cloud environment and other networks which are similar to wireless networks MANET. These models can be easily programmed and implemented on computer networks.

Adaptation by Design: A Context-Sensitive, Dialogic Approach to Interventions

ERIC Educational Resources Information Center

Kirshner, Ben; Polman, Joseph L.

2013-01-01

Applied researchers, whether working with the framework of design-based research or intervention science, face a similar implementation challenge: practitioners who enact their programs typically do so in varied, context-specific ways. Although this variability is often seen as a problem for those who privilege fidelity and standardization, we…

The Scope and Design of Structured Group Learning Experiences at Community Colleges

ERIC Educational Resources Information Center

Hatch, Deryl K.; Bohlig, E. Michael

2015-01-01

This study explores through descriptive analysis the similarities of structured group learning experiences such as first-year seminars, learning communities, orientation, success courses, and accelerated developmental education programs, in terms of their design features and implementation at community colleges. The study takes as its conceptual…

Developing a Bachelor's Program in Health Information Technology

ERIC Educational Resources Information Center

Howard, Elizabeth V.; Bishop-Clark, Cathy; Evans, Donna M.; Rose, Anthony W.

2013-01-01

There is little doubt that the healthcare industry is experiencing tremendous growth in regards to technology. If you have visited a healthcare professional recently, you may have seen a similar notice, "Please be patient as we implement a new electronic healthcare record system." This confluence of technology and healthcare provides a…

Lost in folding space? Comparing four variants of the thermodynamic model for RNA secondary structure prediction.

PubMed

Janssen, Stefan; Schudoma, Christian; Steger, Gerhard; Giegerich, Robert

2011-11-03

Many bioinformatics tools for RNA secondary structure analysis are based on a thermodynamic model of RNA folding. They predict a single, "optimal" structure by free energy minimization, they enumerate near-optimal structures, they compute base pair probabilities and dot plots, representative structures of different abstract shapes, or Boltzmann probabilities of structures and shapes. Although all programs refer to the same physical model, they implement it with considerable variation for different tasks, and little is known about the effects of heuristic assumptions and model simplifications used by the programs on the outcome of the analysis. We extract four different models of the thermodynamic folding space which underlie the programs RNAFOLD, RNASHAPES, and RNASUBOPT. Their differences lie within the details of the energy model and the granularity of the folding space. We implement probabilistic shape analysis for all models, and introduce the shape probability shift as a robust measure of model similarity. Using four data sets derived from experimentally solved structures, we provide a quantitative evaluation of the model differences. We find that search space granularity affects the computed shape probabilities less than the over- or underapproximation of free energy by a simplified energy model. Still, the approximations perform similar enough to implementations of the full model to justify their continued use in settings where computational constraints call for simpler algorithms. On the side, we observe that the rarely used level 2 shapes, which predict the complete arrangement of helices, multiloops, internal loops and bulges, include the "true" shape in a rather small number of predicted high probability shapes. This calls for an investigation of new strategies to extract high probability members from the (very large) level 2 shape space of an RNA sequence. We provide implementations of all four models, written in a declarative style that makes them easy to be modified. Based on our study, future work on thermodynamic RNA folding may make a choice of model based on our empirical data. It can take our implementations as a starting point for further program development.

Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM).

PubMed

Meshkat, Nazanin; Teklu, Sisay; Hunchak, Cheryl

2018-04-06

To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. The needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs. We have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs.

Harnessing Protocolized Adaptation in Dissemination: Successful Implementation and Sustainment of the Veterans Affairs Coordinated-Transitional Care Program in a Non-Veterans Affairs Hospital.

PubMed

Kind, Amy J H; Brenny-Fitzpatrick, Maria; Leahy-Gross, Kris; Mirr, Jacquelyn; Chapman, Elizabeth; Frey, Brooke; Houlahan, Beth

2016-02-01

The Department of Veterans Affairs (VA) Coordinated-Transitional Care (C-TraC) program is a low-cost transitional care program that uses hospital-based nurse case managers, inpatient team integration, and in-depth posthospital telephone contacts to support high-risk patients and their caregivers as they transition from hospital to community. The low-cost, primarily telephone-based C-TraC program reduced 30-day rehospitalizations by one-third, leading to significant cost savings at one VA hospital. Non-VA hospitals have expressed interest in launching C-TraC, but non-VA hospitals differ in important ways from VA hospitals, particularly in terms of context, culture, and resources. The objective of this project was to adapt C-TraC to the specific context of one non-VA setting using a modified Replicating Effective Programs (REP) implementation theory model and to test the feasibility of this protocolized implementation approach. The modified REP model uses a mentored phased-based implementation with intensive preimplementation activities and harnesses key local stakeholders to adapt processes and goals to local context. Using this protocolized implementation approach, an adapted C-TraC protocol was created and launched at the non-VA hospital in July 2013. In its first 16 months, C-TraC successfully enrolled 1,247 individuals with 3.2 full-time nurse case managers, achieving good fidelity for core protocol steps. C-TraC participants experienced a 30-day rehospitalization rate of 10.8%, compared with 16.6% for a contemporary comparison group of similar individuals for whom C-TraC was not available (n = 1,307) (P < .001). The new C-TraC program continues in operation. Use of a modified REP model to guide protocolized adaptation to local context resulted in a C-TraC program that was feasible and sustained in a real-world non-VA setting. A modified REP implementation framework may be an appropriate foundational step for other clinical programs seeking to harness protocolized adaptation in mentored dissemination activities. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Using Evidence-Based Interventions to Improve Cancer Screening in the National Breast and Cervical Cancer Early Detection Program.

PubMed

DeGroff, Amy; Carter, Aundrea; Kenney, Kristy; Myles, Zachary; Melillo, Stephanie; Royalty, Janet; Rice, Ketra; Gressard, Lindsay; Miller, Jacqueline W

2016-01-01

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening to low-income, un-, and underinsured women through more than 11 000 primary care clinics. The program is well-positioned to work with health systems to implement evidence-based interventions (EBIs) to increase screening among all women. To collect baseline data on EBI use, evaluation of EBIs, and related training needs among NBCCEDP grantees. The Centers for Disease Control and Prevention conducted a Web-based survey in late 2013 among NBCCEDP grantees for the period July 2012 to June 2013. This was the first systematic assessment of EBIs among NBCCEDP grantees. The Centers for Disease Control and Prevention's NBCCEDP. Primarily program directors/coordinators for all 67 NBCCEDP grantees. Data captured were used to assess implementation of 5 EBIs, their evaluation, and related training needs. Frequencies and proportions were determined. Cluster analysis identified grantees with similar patterns of EBI use for NBCCEDP clients and providers. On average, 4.1 of 5 EBIs were implemented per grantee for NBCCEDP clients and providers. Four clusters were identified including "high overall EBI users," "high provider EBI users," "high EBI users with no provider assessment and feedback," and "high client EBI users." Only 1.8 EBIs were implemented, on average, with non-NBCCEDP clients and providers. Fewer than half (n = 32, 47.8%) of grantees conducted process or outcome evaluation of 1 or more EBIs. Overall, 47.6% of grantees reported high or medium training needs for client-oriented EBIs and 54.3% for provider-oriented EBIs. The NBCCEDP grantees are implementing EBIs extensively with clients and providers. Increased EBI use among non-NBCCEDP clients/providers is needed to extend the NBCCEDP's reach and impact. Grantee training and technical assistance is necessary across EBIs. In addition, grantees' use of process and outcome evaluation of EBI implementation must be increased to inform effective program implementation.

What Does it Mean to Be a STEM School: A Comparison of Science Programs

NASA Astrophysics Data System (ADS)

Stanley, Rebecca Matthews

Schools that focus on science, technology, engineering, and mathematics (STEM) have been created to address a perceived need to increase numbers of students in the United States choosing and persisting in STEM career pathways. This study compared science programs in STEM and non-STEM high schools to determine how implementing a STEM design impacts science, a cornerstone of STEM. The multiple case study examined STEM integration, science instruction, and extracurricular opportunities in four high schools, two that were designated as STEM by the state's department of instruction and two that were comparable but did not have a focus on STEM. Results from this study indicate that STEM and non-STEM science programs are not significantly different in the schools studied. The two major differences that were found, greater incorporation of engineering design and increased access to extracurricular STEM activities, did not have beneficial impact on students' attitudes or career choices. Technology and math integration were similar but STEM schools integrated engineering design whereas non-STEM schools did not. Science instruction was similar. The numbers of observed inquiry-based lessons were similar, however, STEM schools had more project-based lessons, a form of inquiry-based instruction in which students create a product. A higher number of science-based extracurricular opportunities was available to students in STEM than non- STEM schools. This study offers important insight into the implementation of STEM education within existing school contexts and constraints.

Interprofessional education development: not for the faint of heart

PubMed Central

Fahs, Deborah B; Honan, Linda; Gonzalez-Colaso, Rosana; Colson, Eve R

2017-01-01

Interprofessional education (IPE) has the potential to improve communication, collaboration and coordination of care, leading to improved health care outcomes. Promoting IPE has become an aim for many professional schools. However, there are challenges to implementing meaningful curricula that involve multiple health care professional schools. In this study, we outline 12 lessons learned when designing and implementing an Interprofessional Longitudinal Clinical Experience (ILCE) for 247 students from a School of Nursing, Medicine and Physician Associate Program in New England. Lessons learned over 4 years include pilot, evaluate and refine projects; create a formal interprofessional organizational structure; involve faculty who are passionate ambassadors for IPE; procure and maintain financial support; recognize power struggles and bias; overcome logistical conundrums to realize common goals, secure clinical sites and prepare IPE coaches; expect there will always be another hurdle; do not go it alone; recruit experts; recognize role differentiation and similarities; be aware of fragility of students and faculty and collect data to assess, evaluate, improve and gain buy-in. We were able to successfully implement a large program for students from three different health care professional schools that takes place in the clinical setting with faculty coaches, patients and their families. We hope that the lessons learned can be instructive to those considering a similar effort. PMID:28553153

A portable MPI-based parallel vector template library

NASA Technical Reports Server (NTRS)

Sheffler, Thomas J.

1995-01-01

This paper discusses the design and implementation of a polymorphic collection library for distributed address-space parallel computers. The library provides a data-parallel programming model for C++ by providing three main components: a single generic collection class, generic algorithms over collections, and generic algebraic combining functions. Collection elements are the fourth component of a program written using the library and may be either of the built-in types of C or of user-defined types. Many ideas are borrowed from the Standard Template Library (STL) of C++, although a restricted programming model is proposed because of the distributed address-space memory model assumed. Whereas the STL provides standard collections and implementations of algorithms for uniprocessors, this paper advocates standardizing interfaces that may be customized for different parallel computers. Just as the STL attempts to increase programmer productivity through code reuse, a similar standard for parallel computers could provide programmers with a standard set of algorithms portable across many different architectures. The efficacy of this approach is verified by examining performance data collected from an initial implementation of the library running on an IBM SP-2 and an Intel Paragon.

A Portable MPI-Based Parallel Vector Template Library

NASA Technical Reports Server (NTRS)

Sheffler, Thomas J.

1995-01-01

This paper discusses the design and implementation of a polymorphic collection library for distributed address-space parallel computers. The library provides a data-parallel programming model for C + + by providing three main components: a single generic collection class, generic algorithms over collections, and generic algebraic combining functions. Collection elements are the fourth component of a program written using the library and may be either of the built-in types of c or of user-defined types. Many ideas are borrowed from the Standard Template Library (STL) of C++, although a restricted programming model is proposed because of the distributed address-space memory model assumed. Whereas the STL provides standard collections and implementations of algorithms for uniprocessors, this paper advocates standardizing interfaces that may be customized for different parallel computers. Just as the STL attempts to increase programmer productivity through code reuse, a similar standard for parallel computers could provide programmers with a standard set of algorithms portable across many different architectures. The efficacy of this approach is verified by examining performance data collected from an initial implementation of the library running on an IBM SP-2 and an Intel Paragon.

Thai district Leaders' perceptions of managing the direct observation treatment program in Trang Province, Thailand.

PubMed

Choowong, Jiraporn; Tillgren, Per; Söderbäck, Maja

2016-07-28

Thailand is 18th out of the 22 countries with the highest tuberculosis (TB) burden. It will be a challenge for Thailand to achieve the UN Millennium Development target for TB, as well as the new WHO targets for eliminating TB by 2035. More knowledge and a new approach are needed to tackle the complex challenges of managing the DOT program in Thailand. Contextual factors strongly influence the local implementation of evidence in practice. Using the PARIHS model, the aim has been to explore district leaders' perceptions of the management of the DOT program in Trang province, Thailand. A phenomenographic approach was used to explore the perceptions among district DOT program leaders in Trang province. We conducted semi-structured interviews with district leaders responsible for managing the DOT program in five districts. The analysis of the data transcriptions was done by grouping similarities and differences of perceptions, which were constructed in a hierarchical outcome space that shows a set of descriptive categories. The first descriptive category revealed a common perception of the leaders' duty and wish to comply with the NTP guidelines when managing and implementing the DOT program in their districts. More varied perceptions among the leaders concerned how to achieve successful treatment. Other perceptions concerned practical dilemmas, which included fear of infection, mutual distrust, and inadequate knowledge about TB. Further, the leaders perceived a need for improved management practices in implementing the TB guidelines. Using the PARIHS framework to gain a retrospective perspective on the district-level policy implementation of the DOT program and studying the leadership's perceptions about applying the guidelines to practice, has brought new knowledge about management practices. Additional support and resources from the regional level are needed to manage the challenges.

[Western area surge for controlling Ebola hemorrhagic fever outbreak in Sierra Leone and evaluation of its effect].

PubMed

Chen, Yong; Wu, Dan; Zhang, Wenyi; Chen, Zeliang; Chang, Guohui; Tian, Shuguang; Yang, Ruifu; Liu, Chao

2015-10-01

To investigate the Western Area Surge (WAS) program in the Ebola outbreak of Sierra Leone, and to analyze its implementing effect. The subject of this study was 3,813 laboratory confirmed Ebola hemorrhagic fever (EHF) cases reported in Sierra Leone from November 19, 2014 through January 27, 2015, a period before and after the implementation of the WAS program. To analyze and make conclusions according to the working experience of China Mobile Laboratory Reponses Team in the fight of Ebola outbreak, using WHO published EHF case definition to make diagnosis and compare the number of bed numbers, confirmed EHF cases, samples tested, and positive rates before and after implementation of WAS program. From the implementation of WAS program on 17th December 2014 to half a month later, the total numbers of Ebola holding and treatment centers increased from 640 to 960, six additional laboratories were established. On January, 2015, another two laboratories from America and The Netherlands were established. The numbers of samples tested one month before and after WAS program were 7,891 and 9,783, respectively, with an increase of 24.0 percent, while the positive rate of Ebola virus decreased from 22.2% (1,752/7,891) to 11.0% (1,077/9,783). The positive rate of blood samples decreased from 39.6% (248/626) in the month before WAS program to 27.4% (131/478) (χ2=17.93, P<0.001) in the mother after WAS program, the positive rate of blood samples 22.7% (103/454) to 10% (62/609) (χ2=31.03, P<0.001), accordingly. After 3 weeks of WAS program, in addition to Western Area, another four hotspots in Sierra Leone had also reported a significant decrease of the numbers of confirmed EVD cases. Forty-two days after implementation of WAS program, the daily number of laboratory confirmed EHF cases decreased from 63 to 10. WAS program played a vital role in controlling the EHF outbreak rapidly in Sierra Leone. It could also provide guidance for the control similar large infectious diseases outbreak in the future.

Association of Rapid Care Process Implementation on Reperfusion Times Across Multiple ST-Segment-Elevation Myocardial Infarction Networks.

PubMed

Fordyce, Christopher B; Al-Khalidi, Hussein R; Jollis, James G; Roettig, Mayme L; Gu, Joan; Bagai, Akshay; Berger, Peter B; Corbett, Claire C; Dauerman, Harold L; Fox, Kathleen; Garvey, J Lee; Henry, Timothy D; Rokos, Ivan C; Sherwood, Matthew W; Wilson, B Hadley; Granger, Christopher B

2017-01-01

The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement. Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001). The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass. © 2017 American Heart Association, Inc.

Implementation of a University-wide Retention Model

NASA Astrophysics Data System (ADS)

Davis, E. J.; Campbell, A.

2006-12-01

Eleven years ago, Bowie State University and NASA Goddard Space Flight Center entered into an agreement to enhance the science, mathematics, engineering and technology /(SMET/) domains. A Model Institutions for Excellence Award provided the financial basis for a number of initiatives that have led to increased retention and graduation rates. Initiatives such as a scholarship program, tutoring center, Summer Academy, safety-net program, research focus and mentoring have had a significant impact on students entering graduate and professional school and SMET related employment. Successes documented through various assessment activities and tracking of student progress, have led to implementation of the `retention model' urilized by the SMET MIE Initiatives throughout the University. The MIE retention efforts include each of the aforementioned initiatives plus pre-college and second-year experience programs. It is anticipated that the University-wide application of the `retention model' will provide the incentives necessary to obtain similar results throughout the student body.

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

PubMed

Licskai, Christopher; Sands, Todd; Ong, Michael; Paolatto, Lisa; Nicoletti, Ivan

2012-10-01

Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ± 24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ± 7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1.

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

PubMed Central

Licskai, Christopher; Sands, Todd; Ong, Michael; Paolatto, Lisa; Nicoletti, Ivan

2012-01-01

Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1 PMID:22893665

Supporting Faculty Development in Hospital Medicine: Design and Implementation of a Personalized Structured Mentoring Program.

PubMed

Nagarur, Amulya; O'Neill, Regina M; Lawton, Donna; Greenwald, Jeffrey L

2018-02-01

The guidance of a mentor can have a tremendous influence on the careers of academic physicians. The lack of mentorship in the relatively young field of hospital medicine has been documented, but the efficacy of formalized mentorship programs has not been well studied. We implemented and evaluated a structured mentorship program for junior faculty at a large academic medical center. Of the 16 mentees who participated in the mentorship program, 14 (88%) completed preintervention surveys and 10 (63%) completed postintervention surveys. After completing the program, there was a statistically significant improvement in overall satisfaction within 5 specific domains: career planning, professional connectedness, self-reflection, research skills, and mentoring skills. All mentees reported that they would recommend that all hospital medicine faculty participate in similar mentorship programs. In this small, single-center pilot study, we found that the addition of a structured mentorship program based on training sessions that focus on best practices in mentoring was feasible and led to increased satisfaction in certain career domains among early-career hospitalists. Larger prospective studies with a longer follow-up are needed to assess the generalizability and durability of our findings. © 2017 Society of Hospital Medicine.

The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations

PubMed Central

Ngo, Victoria K.; Weiss, Bahr; Lam, Trung; Dang, Thanh; Nguyen, Tam; Nguyen, Mai Hien

2014-01-01

In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings. PMID:25568593

Grade pending: lessons for hospital quality reporting from the New York City restaurant sanitation inspection program.

PubMed

Ryan, Andrew M; Detsky, Allan S

2015-02-01

Public quality reporting programs have been widely implemented in hospitals in an effort to improve quality and safety. One such program is Hospital Compare, Medicare's national quality reporting program for US hospitals. The New York City sanitary grade inspection program is a parallel effort for restaurants. The aims of Hospital Compare and the New York City sanitary inspection program are fundamentally similar: to address a common market failure resulting from consumers' lack of information on quality and safety. However, by displaying easily understandable information at the point of service, the New York City sanitary inspection program is better designed to encourage informed consumer decision making. We argue that this program holds important lessons for public quality reporting of US hospitals. © 2014 Society of Hospital Medicine.

A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

PubMed Central

2013-01-01

Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities.

PubMed

Kottke, Thomas E; Pronk, Nico; Zinkel, Andrew R; Isham, George J

2017-01-01

Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy.In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined.

Impact of Implementation of Direct Cash Transfer Program 2008/2009 on Household Consumption in Central Java Province

NASA Astrophysics Data System (ADS)

Subanti, S.; Hakim, A. R.; Hakim, I. M.

2017-04-01

This study aims to see the impact of direct cash transfer program for 2008/2009 on household consumption of food, nonfood, education, and health in Central Java Province. The study is expected to provide important findings for the improvement of a similar program in the future. This study findings that (1) the increasing in food and non-food consumption for direct cash transfer recipients than non direct cash transfer recipients; (2) the impact of households expenditure on education for direct cash transfer recipients is higher than non direct cash transfer recipients; (3) the impact of households expenditure on health for direct cash transfer recipients is lower than non direct cash transfer recipients. This study recommended that (1) implementation of direct cash transfer program 2008/2009 must be managed to be better because this program can defend household welfare. It shows from several indicators of well-being such as consumption spending, education, and health; (2) data targets for poor households (very poor, poor, nearly poor) must be updated.

Barter to Beat Inflation: Developing a Neighborhood Network for Swapping Services on Behalf of the Aged.

ERIC Educational Resources Information Center

Noberini, Mary Rose; Berman, Rochel U.

1983-01-01

Presents an urban neighborhood network barter model which can facilitate service delivery to the elderly and offers recommendations for implementing a similar program. Community outreach, good publicity, and a successful conference were key factors in producing a greater sense of cohesiveness within the community. (JAC)

Project RESOURCES: Retired Employees Skills Outreach Using Retirees in Continuing Employment Situations. A Manual.

ERIC Educational Resources Information Center

Yoseloff, Darlene; And Others

Project RESOURCES (Retired Employees Skills Outreach Using Retirees in Continuing Employment Situations) was developed at Middlesex County College (MCC) to meet the employment needs of the over 55 age population. Designed to assist others in implementing similar programs, this manual provides an overview of the project, including information on…

78 FR 57885 - Report on the Criteria and Methodology for Determining the Eligibility of Candidate Countries for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

...: Sources: Sources: Quarterly reporting Indicator tracking Quarterly tables reporting. Survey of MCC staff Quarterly reporting GAO Audits. Impact evaluations Survey of MCC staff. Similarly, the Board may consider a... reporting, documentation of changes in timing or scope of a threshold program in implementation, a survey of...

Provider Agency Practices as a Source of Social Work EBP.

PubMed

Blakely, Thomas J; Dziadosz, Gregory M

2016-01-01

Through this article the authors propose that agency service provider systems may be a source of evidence-based practices (EBP). One agency's design and implementation of a program entitled Community Treatment and Rehabilitation is presented as an example. The elements of this program conform to the creation of EBPs. It was formulated with consideration of clients' values and judgments through their participation at every step in the assessment and treatment process. Staff clinicians were trained in established EBP interventions, such as cognitive therapy, embedded in a system of ordered assessment, treatment, and outcome evaluation. A controlled research design was used to gather outcome data to inform clinicians' decisions about interventions that were then systematically applied with clients. The delivery system was organized for clinical supervisors to guide staff clinical practices so that all were operating on the same set of guidelines allowing for similar outcomes to occur with similar interventions. This method of developing EBPs makes them available for application immediately and successfully eliminates the delay between development and implementation that usually occurs with other sources of EBPs.

Implementation of the Hungarian Algorithm to Account for Ligand Symmetry and Similarity in Structure-Based Design

PubMed Central

2015-01-01

False negative docking outcomes for highly symmetric molecules are a barrier to the accurate evaluation of docking programs, scoring functions, and protocols. This work describes an implementation of a symmetry-corrected root-mean-square deviation (RMSD) method into the program DOCK based on the Hungarian algorithm for solving the minimum assignment problem, which dynamically assigns atom correspondence in molecules with symmetry. The algorithm adds only a trivial amount of computation time to the RMSD calculations and is shown to increase the reported overall docking success rate by approximately 5% when tested over 1043 receptor–ligand systems. For some families of protein systems the results are even more dramatic, with success rate increases up to 16.7%. Several additional applications of the method are also presented including as a pairwise similarity metric to compare molecules during de novo design, as a scoring function to rank-order virtual screening results, and for the analysis of trajectories from molecular dynamics simulation. The new method, including source code, is available to registered users of DOCK6 (http://dock.compbio.ucsf.edu). PMID:24410429

Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.

PubMed

Percac-Lima, Sanja; Ashburner, Jeffrey M; Bond, Barbara; Oo, Sarah A; Atlas, Steven J

2013-11-01

Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening. Retrospective program evaluation of an implemented intervention. Women who self-identified as speaking Somali, Arabic, or Serbo-Croatian (Bosnian) and were eligible for breast cancer screening at an urban community health center (HC). Comparison groups were English-speaking and Spanish-speaking women eligible for breast cancer screening in the same HC. Patient navigators educated women about breast cancer screening, explored barriers to screening, and tailored interventions individually to help complete screening. Adjusted 2-year mammography rates from logistic regression models for each calendar year accounting for clustering by primary care physician. Rates in refugee women were compared to English-speaking and Spanish-speaking women in the year before implementation of the PN program and over its first 3 years. There were 188 refugee (36 Somali, 48 Arabic, 104 Serbo-Croatian speaking), 2,072 English-speaking, and 2,014 Spanish-speaking women eligible for breast cancer screening over the 4-year study period. In the year prior to implementation of the program, adjusted mammography rates were lower among refugee women (64.1 %, 95 % CI: 49-77 %) compared to English-speaking (76.5 %, 95 % CI: 69 %-83 %) and Spanish-speaking (85.2 %, 95 % CI: 79 %-90 %) women. By the end of 2011, screening rates increased in refugee women (81.2 %, 95 % CI: 72 %-88 %), and were similar to the rates in English-speaking (80.0 %, 95 % CI: 73 %-86 %) and Spanish-speaking (87.6 %, 95 % CI: 82 %-91 %) women. PN increased screening rates in both younger and older refugee women. Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.

Helicopter rotor loads using matched asymptotic expansions: User's manual

NASA Technical Reports Server (NTRS)

Pierce, G. A.; Vaidyanathan, A. R.

1983-01-01

Computer programs were developed to implement the computational scheme arising from Van Holten's asymptotic method for calculating airloads on a helicopter rotor blade in forward flight, and a similar technique which is based on a discretized version of the method. The basic outlines of the two programs are presented, followed by separate descriptions of the input requirements and output format. Two examples illustrating job entry with appropriate input data and corresponding output are included. Appendices contain a sample table of lift coefficient data for the NACA 0012 air foil and listings of the two programs.

Factors Influencing the Accuracy of Aerodynamic Hinge-Moment Prediction

DTIC Science & Technology

1978-08-01

condition on the aft lifting surfaces and flaps. A new modeling technique for trailing-edge wake analysis using a potential- flow program based on the...control surface as depicLed in figure 21.. Three different models are used to simulate the flow on the wing, the flap, and the gaps. In the first two panel...ized sense, similar to that implemented in the FLEXSTAB program. The modeling of the wake on the side-edge gaps differs in the first two panel models

Cost and logistics of implementing a tissue-based American College of Surgeons/Association of Program Directors in Surgery surgical skills curriculum for general surgery residents of all clinical years.

PubMed

Henry, Brandon; Clark, Philip; Sudan, Ranjan

2014-02-01

The cost and logistics of deploying the American College of Surgeons (ACS)/Association of Program Directors in Surgery (APDS) National Technical Skills Curriculum across all training years are not known. This information is essential for residency programs choosing to adopt similar curricula. A task force evaluated the authors' institution's existing simulation curriculum and enhanced it by implementing the ACS/APDS modules. A 35-module curriculum was administered to 35 general surgery residents across all 5 clinical years. The costs and logistics were noted, and resident satisfaction was assessed. The annual operational cost was $110,300 ($3,150 per resident). Cost per module, per resident was $940 for the cadaveric module compared with $220 and $240 for dry simulation and animal tissue-based modules, respectively. Resident satisfaction improved from 2.45 to 4.78 on a 5-point, Likert-type scale after implementing the ACS/APDS modules. The ACS/APDS skills curriculum was implemented successfully across all clinical years. Cadaveric modules were the most expensive. Animal and dry simulation modules were equivalent in cost. The addition of tissue-based modules was associated with high satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

Medicaid-based child restraint system disbursement and education and the vaccines for children program: comparative cost-effectiveness.

PubMed

Goldstein, Jesse A; Winston, Flaura K; Kallan, Michael J; Branas, Charles C; Schwartz, J Sanford

2008-01-01

Low-income children are disproportionately at risk for preventable motor-vehicle injury. Many of these children are covered by Medicaid programs placing substantial economic burden on states. Child restraint systems (CRSs) have demonstrated efficacy in preventing death and injury among children in crashes but remain underutilized because of poor access and education. The objective of this study was to evaluate the cost-effectiveness of Medicaid-based reimbursement for CRS disbursement and education for low-income children and compare it with vaccinations covered under the Vaccines For Children (VFC) program. A cost-effectiveness analysis was performed of Medicaid reimbursement for CRS disbursement/education for low-income children based on data from public and private databases. Primary outcomes measured include cost per life-year saved, death, serious injury, and minor injury averted, as well as medical, parental work loss, and future productivity loss costs averted. Cost-effectiveness calculations were compared with published cost-effectiveness data for vaccinations covered under the VFC program. The adoption of a CRS disbursement/education program could prevent up to 2 deaths, 12 serious injuries, and 51 minor injuries per 100,000 low-income children annually. When fully implemented, the program could save Medicaid over $1 million per 100,000 children in direct medical costs while costing $13 per child per year after all 8 years of benefit. From the perspective of Medicaid, the program would cost $17,000 per life-year saved, $60,000 per serious injury prevented, and $560,000 per death averted. The program would be cost saving from a societal perspective. These data are similar to published vaccination cost-effectiveness data. Implementation of a Medicaid-funded CRS disbursement/education program was comparable in cost-effectiveness with federal vaccination programs targeted toward similar populations and represents an important potential strategy for addressing injury disparities among low-income children.

Tile Surface Thermocouple Measurement Challenges from the Orbiter Boundary Layer Transition Flight Experiment

NASA Technical Reports Server (NTRS)

Campbell, Charles H.; Berger, Karen; Anderson, Brian

2012-01-01

Hypersonic entry flight testing motivated by efforts seeking to characterize boundary layer transition on the Space Shuttle Orbiters have identified challenges in our ability to acquire high quality quantitative surface temperature measurements versus time. Five missions near the end of the Space Shuttle Program implemented a tile surface protuberance as a boundary layer trip together with tile surface thermocouples to capture temperature measurements during entry. Similar engineering implementations of these measurements on Discovery and Endeavor demonstrated unexpected measurement voltage response during the high heating portion of the entry trajectory. An assessment has been performed to characterize possible causes of the issues experienced during STS-119, STS-128, STS-131, STS-133 and STS-134 as well as similar issues encountered during other orbiter entries.

Cockpit Resource Management (CRM) training in the 1550th combat crew training wing

NASA Technical Reports Server (NTRS)

Fiedler, Michael T.

1987-01-01

The training program the 1550th Combat Crew Training Wing at Kirtland Air Force Base, New Mexico, implemented in September 1985 is discussed. The program is called Aircrew Coordination Training (ACT), and it is designed specifically to help aircrew members work more effectively as a team in their respective aircraft and hopefully to reduce human factors-related accidents. The scope of the 1550th CCTW's training responsibilities is described, the structure of the program, along with a brief look at the content of the academic part of the course. Then the Mission-Oriented Simulator Training (MOST) program is discussed; a program similar to the Line Oriented Flight Training (LOFT) programs. Finally, the future plans for the Aircrew Coordination Training Program at the 1550th is discussed.

Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program.

PubMed

Shaffer, Virginia O; Owi, Tari; Kumarusamy, Mathu A; Sullivan, Patrick S; Srinivasan, Jahnavi K; Maithel, Shishir K; Staley, Charles A; Sweeney, John F; Esper, Greg

2017-04-01

Nearly 30% of patients with newly formed ileostomies require hospital readmission from severe dehydration or associated complications. This contributes to significant morbidity and rising healthcare costs associated with this procedure. Our aim was to design and pilot a novel program to decrease readmissions in this patient population. An agreement was established with Visiting Nurse Health System (VNHS) in March 2015 that incorporated regular home visits with clinical triggers to institute surgeon-supervised corrective measures aimed at preventing patient decompensation associated with hospital readmissions. Thirty-day readmission data for patients managed with and without VNHS support for 10.5 months before and after implementation of this new program were collected. Of 833 patients with small bowel procedures, 162 were ileostomies with 47 in the VNHS and 115 in the non-VNHS group. Before program implementation, VNHS (n = 24) and non-VNHS patients (n = 54) had similar readmission rates (20.8% vs 16.7%). After implementation, VNHS patients (n = 23) had a 58% reduction in hospital readmission (8.7%) and non-VNHS patient hospital readmissions (n = 61) increased slightly (24.5%). Total cost of readmissions per patient in the cohort decreased by >80% in the pilot VNHS group. Implementation of a novel program reduced the 30-day readmission rate by 58% and cost of readmissions per patient by >80% in a high risk for readmission patient population with newly created ileostomies. Future efforts will expand this program to a greater number of patients, both institutionally and systemically, to reduce the readmission-rate and healthcare costs for this high-risk patient population. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

PubMed

Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

2013-11-01

Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

Utilizing the "Plan, Do, Study, Act" Framework to Explore the Process of Curricular Assessment and Redesign in a Physical Therapy Education Program in Suriname.

PubMed

Audette, Jennifer Gail; Baldew, Se-Sergio; Chang, Tony C M S; de Vries, Jessica; Ho A Tham, Nancy; Janssen, Johanna; Vyt, Andre

2017-01-01

To describe how a multinational team worked together to transition a physical therapy (PT) educational program in Paramaribo, Suriname, from a Bachelor level to a Master of Science in Physical Therapy (MSPT) level. The team was made up of PT faculty from Anton De Kom Universiteit van Suriname (AdeKUS), the Flemish Interuniversity Council University Development Cooperation (VLIR-UOS) leadership, and Health Volunteers Overseas volunteers. In this case study, the process for curricular assessment, redesign, and upgrade is described retrospectively using a Plan, Do, Study, Act (PDSA) framework. PT educational programs in developing countries are eager for upgrade to meet international expectations and to better meet community health-care needs. An ongoing process which included baseline assessment of all aspects of the existing bachelor's program in PT, development of a plan for a MSPT, implementation of the master's program, and evaluation following implementation is described. Curricular assessment and upgrade in resource-limited countries requires the implementation of process-oriented methods. The PDSA process is a useful tool to explore curricular development. The international collaboration described in this paper provides an example of the diligence, consistency, and dedication required to see a project through and achieve success while providing adequate support to the host site. This project might provide valuable insights for those involved in curricular redesign in similar settings.

The antimicrobial resistance monitoring and research (ARMoR) program: the US Department of Defense response to escalating antimicrobial resistance.

PubMed

Lesho, Emil P; Waterman, Paige E; Chukwuma, Uzo; McAuliffe, Kathryn; Neumann, Charlotte; Julius, Michael D; Crouch, Helen; Chandrasekera, Ruvani; English, Judith F; Clifford, Robert J; Kester, Kent E

2014-08-01

Responding to escalating antimicrobial resistance (AMR), the US Department of Defense implemented an enterprise-wide collaboration, the Antimicrobial Resistance Monitoring and Research Program, to aid in infection prevention and control. It consists of a network of epidemiologists, bioinformaticists, microbiology researchers, policy makers, hospital-based infection preventionists, and healthcare providers who collaborate to collect relevant AMR data, conduct centralized molecular characterization, and use AMR characterization feedback to implement appropriate infection prevention and control measures and influence policy. A particularly concerning type of AMR, carbapenem-resistant Enterobacteriaceae, significantly declined after the program was launched. Similarly, there have been no further reports or outbreaks of another concerning type of AMR, colistin resistance in Acinetobacter, in the Department of Defense since the program was initiated. However, bacteria containing AMR-encoding genes are increasing. To update program stakeholders and other healthcare systems facing such challenges, we describe the processes and impact of the program. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Investing in innovation: trade-offs in the costs and cost-efficiency of school feeding using community-based kitchens in Bangladesh.

PubMed

Gelli, Aulo; Suwa, Yuko

2014-09-01

School feeding programs have been a key response to the recent food and economic crises and function to some degree in nearly every country in the world. However, school feeding programs are complex and exhibit different, context-specific models or configurations. To examine the trade-offs, including the costs and cost-efficiency, of an innovative cluster kitchen implementation model in Bangladesh using a standardized framework. A supply chain framework based on international standards was used to provide benchmarks for meaningful comparisons across models. Implementation processes specific to the program in Bangladesh were mapped against this reference to provide a basis for standardized performance measures. Qualitative and quantitative data on key metrics were collected retrospectively using semistructured questionnaires following an ingredients approach, including both financial and economic costs. Costs were standardized to a 200-feeding-day year and 700 kcal daily. The cluster kitchen model had similarities with the semidecentralized model and outsourced models in the literature, the main differences involving implementation scale, scale of purchasing volumes, and frequency of purchasing. Two important features stand out in terms of implementation: the nutritional quality of meals and the level of community involvement. The standardized full cost per child per year was US$110. Despite the nutritious content of the meals, the overall cost-efficiency in cost per nutrient output was lower than the benchmark for centralized programs, due mainly to support and start-up costs. Cluster kitchens provide an example of an innovative implementation model, combining an emphasis on quality meal delivery with strong community engagement. However, the standardized costs-per child were above the average benchmarks for both low-and middle-income countries. In contrast to the existing benchmark data from mature, centralized models, the main cost drivers of the program were associated with support and start-up activities. Further research is required to better understand changes in cost drivers as programs mature.

Statewide dissemination of a rural, non-chain restaurant intervention: adoption, implementation and maintenance

PubMed Central

Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.

2014-01-01

The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States, the study targeted randomly selected, non-chain, family-style restaurants. Owners were recruited through mail, then telephone follow-up. Data were collected through telephone at baseline, and 3, 6, 12 and 18 months post-adoption. Using mixed methods, measures captured the program adoption rate, characteristics of adopters and non-adopters, program implementation and maintenance issues, and owner and customer satisfaction. Analyses involved descriptive statistics and summaries of qualitative data. The program adoption rate was 28%. Adopters were similar to responding non-adopters demographically, but varied in attitudes. The majority of restaurants maintained the program for at least 12 months. Adopters and their customers expressed satisfaction with the program. With some adjustments, the RE-AIM model was helpful in guiding evaluation of this process. Results provide implications for future dissemination of this and other programs with regard to research procedures and potential barriers that may be encountered. Research on alternative strategies for widespread dissemination of such programs is needed in this and other settings. PMID:24650944

A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.

PubMed

Axon, Robert N; Penney, Fletcher T; Kyle, Thomas R; Zapka, Jane; Marsden, Justin; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2014-06-01

Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing. Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument. The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries. A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.

Sustainable childhood obesity prevention through community engagement (SCOPE) program: evaluation of the implementation phase.

PubMed

McIntosh, Bonnie; Daly, Amelia; Mâsse, Louise C; Collet, Jean-Paul; Higgins, Joan Wharf; Naylor, Patti-Jean; Amed, Shazhan

2015-10-01

Childhood obesity rates are steadily rising. Sustainable Childhood Obesity Prevention Through Community Engagement (SCOPE) is a community-based participatory action research (PAR) program aimed at preventing childhood obesity. This study aimed to describe community perspectives on, and elicit feedback about, SCOPE's first phase of implementation in two pilot cities in British Columbia, Canada. A case study was implemented using interviews and questionnaires to obtain feedback about SCOPE from two groups: SCOPE coordinators and stakeholders (i.e., individuals and organizations that were a member of the community and engaged with SCOPE coordinators). Participants were recruited via email and (or) by telephone. Coordinators completed a telephone interview. Stakeholders completed a questionnaire and (or) a telephone interview. Thematic analysis was conducted. Participants included 2 coordinators and 15 stakeholders. Participants similarly interpreted SCOPE as a program focused on raising awareness about childhood obesity prevention, while engaging multiple community sectors. Overall, participants valued the program's role in facilitating networking and partnership development, providing evidence-based resources, technical expertise, and contributing funding. Participants felt that SCOPE is sustainable. However, participants felt that barriers to achieving healthy weights among children included those related to the built environment, and social, behavioral, and economic obstacles. Perspectives on factors that facilitated and acted as barriers to SCOPE's first phase of implementation were obtained from the SCOPE communities and may be used to enhance the sustainability of SCOPE and its applicability to other BC communities.

SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

PubMed

Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

2016-01-01

The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

Clumpak: a program for identifying clustering modes and packaging population structure inferences across K.

PubMed

Kopelman, Naama M; Mayzel, Jonathan; Jakobsson, Mattias; Rosenberg, Noah A; Mayrose, Itay

2015-09-01

The identification of the genetic structure of populations from multilocus genotype data has become a central component of modern population-genetic data analysis. Application of model-based clustering programs often entails a number of steps, in which the user considers different modelling assumptions, compares results across different predetermined values of the number of assumed clusters (a parameter typically denoted K), examines multiple independent runs for each fixed value of K, and distinguishes among runs belonging to substantially distinct clustering solutions. Here, we present Clumpak (Cluster Markov Packager Across K), a method that automates the postprocessing of results of model-based population structure analyses. For analysing multiple independent runs at a single K value, Clumpak identifies sets of highly similar runs, separating distinct groups of runs that represent distinct modes in the space of possible solutions. This procedure, which generates a consensus solution for each distinct mode, is performed by the use of a Markov clustering algorithm that relies on a similarity matrix between replicate runs, as computed by the software Clumpp. Next, Clumpak identifies an optimal alignment of inferred clusters across different values of K, extending a similar approach implemented for a fixed K in Clumpp and simplifying the comparison of clustering results across different K values. Clumpak incorporates additional features, such as implementations of methods for choosing K and comparing solutions obtained by different programs, models, or data subsets. Clumpak, available at http://clumpak.tau.ac.il, simplifies the use of model-based analyses of population structure in population genetics and molecular ecology. © 2015 John Wiley & Sons Ltd.

TDRSS system configuration study for space shuttle program

NASA Technical Reports Server (NTRS)

1978-01-01

This study was set up to assure that operation of the shuttle orbiter communications systems met the program requirements when subjected to electrical conditions similar to those which will be encountered during the operational mission. The test program intended to implement an integrated test bed, consisting of applicable orbiter, EVA, payload simulator, STDN, and AF/SCF, as well as the TDRSS equipment. The stated intention of Task 501 Program was to configure the test bed with prototype hardware for a system development test and production hardware for a system verification test. In case of TDRSS when the hardware was not available, simulators whose functional performance was certified to meet appropriate end item specification were used.

Implementing a Social Enterprise Intervention with Homeless, Street-Living Youths in Los Angeles

ERIC Educational Resources Information Center

Ferguson, Kristin M.

2007-01-01

Homeless, street-dwelling youths are an at-risk population who often use survival behaviors to meet their basic needs. The traditional outreach approach brings services into the streets, yet does not adequately replace the youths' high-risk behaviors. Similarly, job training programs often fail to address the mental health issues that constitute…

The Design and Implementation of a Career Orientation Course for Undergraduate Majors

ERIC Educational Resources Information Center

Freeman, Edward

2012-01-01

Over the past several years I have taught a career orientation course at St. John Fisher College. This course was designed to increase student awareness of potential careers following their undergraduate studies in our Biology program. Additionally, the course has also been used as a model for similar experiences in our Psychology, Chemistry,…

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study.

PubMed

Belak, Andrej; Veselska, Zuzana Dankulincova; Geckova, Andrea Madarasova; Dijk, Jitse P van; Reijneveld, Sijmen A

2017-12-13

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP's agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program's merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP's everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs' impact on SDH, their theories and procedures should be adapted according to the programs' more promising actual practice regarding SDH.

Positive youth development programs for adolescents with greater psychosocial needs: evaluation based on program implementers.

PubMed

Shek, Daniel T L; Ng, Catalina S M; Law, Moon Y M

2017-02-01

As program implementers' views are seldom included in program evaluation and there are few related studies in different Chinese communities, this study examined the perceptions of the program implementers who implemented the Tier 2 Program of the P.A.T.H.S. Program in Hong Kong. The Tier 2 Program was designed to promote the development of adolescents with greater psychosocial needs. In the community-based P.A.T.H.S. Project, 400 program implementers completed a subjective outcome evaluation form (Form D) for program implementers. Consistent with the previous findings, program implementers generally held positive views towards the program, implementers, and program effectiveness and their views towards these three domains did not differ across grades. In line with the hypotheses, perceived program quality and perceived implementer quality predicted program effectiveness. The present findings provided an alternative perspective showing that the Tier 2 Program was well received by the program implementers and they regarded the program to be beneficial to the program participants.

Comparison of academic and practice outcomes of rural and traditional track graduates of a family medicine residency program.

PubMed

Petrany, Stephen M; Gress, Todd

2013-06-01

The Marshall University Family Medicine Residency (MUFMR) implemented its rural track (RT) in 1994 to help achieve its mission of producing primary care physicians for practice in rural areas and West Virginia. This study examined the impact of the RT on the program's training outcomes and assessed the academic equivalence of the RT and traditional track (TT) curricula. The authors analyzed academic outcomes (in-training examination [ITE] scores, board certification rates) and practice outcomes (location and type following graduation) for the 174 MUFMR graduates who entered the program from 1984 through 2006. They compared RT and TT graduates who entered after RT implementation (1994-2006) with each other and with graduates who entered during the decade before implementation (1984-1993). There were differences between the 12 RT and 94 TT graduates in rural practice upon graduation (RT: 83% versus TT: 40%; P<.01) and practice in West Virginia (RT 83% versus TT 68%; P=.34). RT and TT graduates had similar mean increases in ITE scores and board certification rates. The 106 post-implementation graduates had a significantly higher rate of West Virginia practice than did the 68 pre-implementation graduates (70% versus 52%; P=.02). RT development was associated with a substantial increase in MUFMR graduates practicing in West Virginia. RT graduates were more likely than TT graduates to practice in rural areas and in the state upon graduation. RT graduates seem to advance academically as well as their TT counterparts.

A multi-stakeholder evaluation of the Baltimore City virtual supermarket program.

PubMed

Lagisetty, Pooja; Flamm, Laura; Rak, Summer; Landgraf, Jessica; Heisler, Michele; Forman, Jane

2017-10-23

Increasing access to healthy foods and beverages in disadvantaged communities is a public health priority due to alarmingly high rates of obesity. The Virtual Supermarket Program (VSP) is a Baltimore City Health Department program that uses online grocery ordering to deliver food to low-income neighborhoods. This study evaluates stakeholder preferences and barriers of program implementation. This study assessed the feasibility, sustainability and efficacy of the VSP by surveying 93 customers and interviewing 14 programmatic stakeholders who had recently used the VSP or been involved with program design and implementation. We identified the following themes: The VSP addressed transportation barriers and food availability. The VSP impacted customers and the city by including improving food purchasing behavior, creating a food justice "brand for the city", and fostering a sense of community. Customers appreciated using Supplemental Nutrition Assistance Program (SNAP) benefits to pay for groceries, but policy changes are needed allow online processing of SNAP benefits. This evaluation summarizes lessons learned and serves as a guide to other public health leaders interested in developing similar programs. Provisions in the U.S. Department of Agriculture (USDA) Farm Bill 2014 allow for select grocers to pilot online transactions with SNAP benefits. If these pilots are efficacious, the VSP model could be easily disseminated.

Public preception on education partnership programs between Indonesia and australia in East Nusa Tenggara Province

NASA Astrophysics Data System (ADS)

Lobo, M.; Guntur, R. D.; Nalley, H. M.

2018-05-01

A research about partnership program in education between the government of Indonesia and Australia in East Nusa Tenggara Province (ENTP) has been conducted. The aim is to list the programs between the countries on the region in the last twenty years, together with their implementations to the community based on all the stakeholders’ perspectives. The samples taken by purposive sampling which targeted those who had direct involvement to the programs in the Districts of Sikka, Ende and Ngada. A literature review, questioners and a depth interview were employed in the data collection. The results show that the main partnership projects were NTT-PEP (Nusa Tenggara Timur-Primary Education Partnership), AIBEP (Australia Indonesia Building Education Project) and ProDEP (Professional Development for Education Personal). While the first and the third programs were targeting on human resources development, the second project was more focusing on the infrastructures. The analysis shows that in general, the majority of people think that the program implementation was good. Similar results were also reflected in the group of superintendent and the community. However, totally different feature was found in the group of government officials where all of them perceived that the program was good and need to be continued and sustained.

The Cost of Saving Electricity Through Energy Efficiency Programs Funded by Utility Customers: 2009–2015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoffman, Ian M.; Goldman, Charles A.; Murphy, Sean

The average cost to utilities to save a kilowatt-hour (kWh) in the United States is 2.5 cents, according to the most comprehensive assessment to date of the cost performance of energy efficiency programs funded by electricity customers. These costs are similar to those documented earlier. Cost-effective efficiency programs help ensure electricity system reliability at the most affordable cost as part of utility planning and implementation activities for resource adequacy. Building on prior studies, Berkeley Lab analyzed the cost performance of 8,790 electricity efficiency programs between 2009 and 2015 for 116 investor-owned utilities and other program administrators in 41 states. Themore » Berkeley Lab database includes programs representing about three-quarters of total spending on electricity efficiency programs in the United States.« less

Ciclovía initiatives: engaging communities, partners and policymakers along the route to success

PubMed Central

Hipp, Aaron; Eyler, Amy A.; Kim, Mi-Sook

2015-01-01

Context Recent efforts to increase physical activity through changes to the built environment have led to strategies and programs that use existing public space including bicycle lanes, temporary parks and the ciclovia initiative (scheduled events in which streets are closed to motorized vehicles and opened for recreational activities) popularized in South America. Objective The current paper describes and compares the processes and structures involved in developing and implementing a ciclovia-type program in two U.S. urban contexts: San Francisco, California, and St. Louis, Missouri. Considering the current growth of and interest in ciclovia initiatives, important outcomes, lessons learned are offered for application in other, similar settings. Design Primary sources from both initiatives and from published research on ciclovias constitute the body of evidence and include: year-end reports, grant applications, meeting minutes, budgets, published ciclovia guidelines, evaluation studies and websites, media sources and interviews and personal communication with the organizers. Main Outcome Measures Primary source documents were reviewed and included in this analysis if they offered information on three grounded questions: What processes were used in developing the initiative? What are the current structures and practices used in implementation of initiatives? What are important lessons learned and best practices from initiatives for recommendations to stakeholders and policy-makers in other contexts? Results Among the categories compared, the structures and processes for implementation regarding buy-in and city department collaboration, route selection, programming, partnerships, media promotion, community outreach and merchant support were relatively similar among the two initiatives. The categories that differed included staffing and volunteer engagement and funding. Conclusion Buy-in from community partners, merchants, residents and city agencies are critical for a positive experience in developing and implementing ciclovia-type initiatives in urban environments. When funding and staffing are inconsistent or limited, the quality and sustainability of the initiative is less certain. PMID:23529059

Otago Exercise Program in the United States: Comparison of 2 Implementation Models.

PubMed

Shubert, Tiffany E; Smith, Matthew L; Goto, Lavina; Jiang, Luohua; Ory, Marcia G

2017-02-01

The Otago Exercise Program (OEP) is an evidence-based fall prevention program delivered by a physical therapist in 6 visits over a year. Despite documented effectiveness, there has been limited adoption of the OEP by physical therapists in the United States. To facilitate dissemination, 2 models have been developed: (1) the US OEP provided by a physical therapist or physical therapist assistant in the home or outpatient setting and (2) the community OEP provided by a non–physical therapist and a physical therapist consultant. It is unknown whether such modifications result in similar outcomes. The aims of this study were to identify the components of these 2 models, to compare participant characteristics for those components reached by each model, and to examine outcome changes by model and between models. This was a translational cohort study with physical therapists implementing the US OEP and trained providers implementing the community OEP. Data for physical performance, sociodemographic characteristics, and self-perception of function were collected at baseline and at 8 weeks. Participants in the community OEP were significantly younger and reported more falls compared with those in US OEP. Both sites reported significant improvements in most physical and self-reported measures of function, with larger effect sizes reported by the community OEP for the Timed “Up & Go” Test. There was no significant difference in improvements in outcome measures between sites. This was an evaluation of a translational research project with limited control over delivery processes. The sample was 96% white, which may limit application to a more diverse population. Alternative, less expensive implementation models of the OEP can achieve results similar to those achieved with traditional methods, especially improvements in Timed “Up & Go” Test scores. The data suggest that the action of doing the exercises may be the essential element of the OEP, providing opportunities to develop and test new delivery models to ensure that the best outcomes are achieved by participants. © 2017 American Physical Therapy Association

Improving Performance of the System Safety Function at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Kiessling, Ed; Tippett, Donald D.; Shivers, Herb

2004-01-01

The Columbia Accident Investigation Board (CAIB) determined that organizational and management issues were significant contributors to the loss of Space Shuttle Columbia. In addition, the CAIB observed similarities between the organizational and management climate that preceded the Challenger accident and the climate that preceded the Columbia accident. To prevent recurrence of adverse organizational and management climates, effective implementation of the system safety function is suggested. Attributes of an effective system safety program are presented. The Marshall Space Flight Center (MSFC) system safety program is analyzed using the attributes. Conclusions and recommendations for improving the MSFC system safety program are offered in this case study.

Summer treatment programs for youth with ADHD.

PubMed

Fabiano, Gregory A; Schatz, Nicole K; Pelham, William E

2014-10-01

Children with attention-deficit/hyperactivity disorder (ADHD) require intensive treatments to remediate functional impairments and promote the development of adaptive skills. The summer treatment program (STP) is an exemplar of intensive treatment of ADHD. STP intervention components include a reward and response-cost point system, time-out, use of antecedent control (clear commands, establishment of rules and routines), and liberal praise and rewards for appropriate behavior. Parents also participate in parent management training programming to learn how to implement similar procedures within the home setting. There is strong evidence supporting the efficacy of the STP as an intervention for ADHD. Copyright © 2014 Elsevier Inc. All rights reserved.

Health promotion in young adults at a university in Korea: A cross-sectional study of 625 participants in a university.

PubMed

Joh, Hee-Kyung; Kim, Hyun-Ji; Kim, Young-Oh; Lee, Jae-Young; Cho, BeLong; Lim, Chun Soo; Jung, Sung-Eun

2017-02-01

Young adulthood is a critical developmental period for establishing life-long health behaviors. However, too little attention has been paid to young adult health promotion. The purpose of this study was to describe the processes of development and implementation involved in a collaborative university-wide health promotion program and to evaluate the achievements of the program.A 3-day university-wide health promotion program was developed and implemented in the nation's largest public university in South Korea in September 2013. Its objectives were to heighten health awareness, to promote healthy behaviors, especially active lifestyle and healthy diet, and to disseminate health knowledge, skills, and access to health resources among young people. The program comprised 14 health lectures, 12 events, and 25 booths. To monitor and evaluate the program, a cross-sectional postevent survey was conducted. A convenience sample of 625 university members who participated in the program was used. The statistics were analyzed with a general linear model and paired t test.The program evaluation demonstrated that this university-wide program effectively provided opportunities for students to access health information, knowledge, skills, self-confidence, and available health services and resources. Participants positively evaluated most of the processes of the program activities and services. Participants' overall evaluation score (83% rated "excellent" or "good") and reparticipation intention (86%) were high. The majority of participants reported increased awareness of health (80%) and the need for a university health promotion program (87%) after the program. Most of the evaluation scores were similarly high for health lectures and booths/events.In conclusion, the university-wide health promotion program was effective in improving university members' health awareness and providing opportunities for students to access various health information and resources. We believe that our results would be useful for sharing information on the planning and implementation of future university health promotion programs.

Health promotion in young adults at a university in Korea

PubMed Central

Joh, Hee-Kyung; Kim, Hyun-Ji; Kim, Young-Oh; Lee, Jae-Young; Cho, BeLong; Lim, Chun Soo; Jung, Sung-Eun

2017-01-01

Abstract Young adulthood is a critical developmental period for establishing life-long health behaviors. However, too little attention has been paid to young adult health promotion. The purpose of this study was to describe the processes of development and implementation involved in a collaborative university-wide health promotion program and to evaluate the achievements of the program. A 3-day university-wide health promotion program was developed and implemented in the nation's largest public university in South Korea in September 2013. Its objectives were to heighten health awareness, to promote healthy behaviors, especially active lifestyle and healthy diet, and to disseminate health knowledge, skills, and access to health resources among young people. The program comprised 14 health lectures, 12 events, and 25 booths. To monitor and evaluate the program, a cross-sectional postevent survey was conducted. A convenience sample of 625 university members who participated in the program was used. The statistics were analyzed with a general linear model and paired t test. The program evaluation demonstrated that this university-wide program effectively provided opportunities for students to access health information, knowledge, skills, self-confidence, and available health services and resources. Participants positively evaluated most of the processes of the program activities and services. Participants’ overall evaluation score (83% rated “excellent” or “good”) and reparticipation intention (86%) were high. The majority of participants reported increased awareness of health (80%) and the need for a university health promotion program (87%) after the program. Most of the evaluation scores were similarly high for health lectures and booths/events. In conclusion, the university-wide health promotion program was effective in improving university members’ health awareness and providing opportunities for students to access various health information and resources. We believe that our results would be useful for sharing information on the planning and implementation of future university health promotion programs. PMID:28207551

Strengthening Environmental Engineering Education in Afghanistan through Cooperating Military Academies

NASA Astrophysics Data System (ADS)

Christ, J. A.; Mahbob, M.; Seely, G. E.; Ressler, S. J.

2007-12-01

Many developing countries suffer from substandard employment of environmental engineering and science principles, which leads to poor management of natural and cultural resources, increased public health concerns, and limitations on economic investment and growth. Thus, prior to the implementation of well-intentioned programs designed to promote development, methods for sustaining basic needs, which are the focus of most environmental engineering disciplines, must be designed into the social fabric of the developing culture. Education is a promising method for fostering this development across cultures. Recently, the US Air Force Academy (USAFA) partnered with the US Military Academy (USMA) to implement a Civil Engineering Program at the National Military Academy of Afghanistan (NMAA), Kabul, Afghanistan. This work will outline the process followed during course development, deployment, and implementation, paying particular attention to challenges and benefits at each stage in the process. This cooperation may serve as a model for future implementation of science, technology, engineering and mathematics education programs in developing countries. Consistent with US Civil Engineering programs, the NMAA Civil Engineering program introduces students to a broad range of introductory-level civil engineering subjects--environmental, hydraulic, geotechnical, structural, construction, and transportation engineering. Basic environmental engineering and science principles are addressed through the implementation of an introductory environmental engineering course. Course development followed a three-stage process: (1) course development by US faculty at their home institution, (2) imbedding of US Faculty at the NMAA, and (3) implementation of the course within the NMAA Civil Engineering curriculum using adjunct Afghan faculty hired from Kabul University. An existing environmental engineering course taught at USAFA was used as a model for course development. Although this existing course provided the necessary framework for the Afghan course, there were a number of challenges with tailoring the course material to the education level, experience, and needs of the Afghan students and faculty. These challenges were overcome, in part, during the imbedding process of US instructors within the NMAA faculty. On-site transfer of course material and knowledge proved a necessary step in the implementation of the course. The imbedding process enabled US instructors to discuss the course with current NMAA faculty and identify an implementation path that met the needs of the program while appreciating the uniqueness of the Afghan experience. Implementation of the course is on-going with reach-back capability for Afghan faculty to continue the mentoring relationship with their US colleagues. Challenges that arise during course implementation (e.g., wet lab deployments, field trip relevance) will be overcome and used as learning tools for future course offerings. Ultimately, this course will provide future leaders of Afghanistan with the educational tools to make informed environmental management decisions and will serve as a model for similar courses implemented throughout Afghanistan.

Development and Evaluation of the Curriculum for BOLD (Bronx Oncology Living Daily) Healthy Living: a Diabetes Prevention and Control Program for Underserved Cancer Survivors.

PubMed

Conlon, Beth A; Kahan, Michelle; Martinez, Melissa; Isaac, Kathleen; Rossi, Amerigo; Skyhart, Rebecca; Wylie-Rosett, Judith; Moadel-Robblee, Alyson

2015-09-01

Underserved minority communities have few resources for addressing comorbidity risk reduction among long-term cancer survivors. To address this community need, we developed and piloted the Bronx Oncology Living Daily (BOLD) Healthy Living program, the first known diabetes prevention and control program to target cancer survivors and co-survivors in Bronx County, NY. The program aimed to facilitate lifestyle change and improve health-related quality of life (HRQoL) through weekly group nutrition education (60-90 min) and exercise (60 min) classes. We examined baseline characteristics of participants using simple descriptive statistics and evaluated program implementation and impact using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. The curriculum, which drew from the social-ecological framework and motivational and cognitive behavioral strategies, consisted of 12 culturally and medically tailored modules with options for implementation as a 12- or 4-week program. Seven programs (four 12 weeks and three 4 weeks in length, respectively) were implemented at five community site locations. Sixty-six cancer survivors and 17 cancer co-survivors (mean age 60.5 ± 10.2 years) enrolled in one of the programs. Most participants were female (95.2 %) minority (55.4 % black, 26.5 % Hispanic/Latino) breast cancer survivors (75.7 %). Median program attendance was 62.5 % and did not significantly differ by program length; however, 67.3 % of participants achieved ≥60 % attendance among the 12-week programs, compared to 41.9 % among the 4-week programs, and this difference was statistically significant (p = 0.02). Overall, participants reported significant pre/post improvements in perceived health as good/excellent (66.0 to 75.5 %; p = 0.001) and borderline significant decreases in perceived pain as moderate/severe (45.5 to 38.2 %; p = 0.05). More than 90 % of participants reported that the program helped them to achieve their short-term goals, motivated them to engage in healthier behaviors, and felt that the nutrition and exercise classes were relevant to their needs. These results indicate that a short-term lifestyle intervention program for adult cancer survivors was acceptable in our community and motivated cancer survivors to improve their HRQoL. The curriculum can be used as a tool to facilitate development of similar programs in the future.

A Design for an Interactive Videodisc Training Program for the Sun Workstation.

DTIC Science & Technology

1984-03-01

level, beginner program. A - l *" Ii. * reply was obtained by asl:ing it the, re2t any cre . t 1 1 t I.t cf -,,I-tL Five sThd thet thv did not - rv more... flowcharts . These three forms spring from the need to specify motion sequences, still frames, and the manner of interaction or branching to be implemented...but should be similar to good over- head transparencies with lots of space between lines. Branching networks or flowcharts are used to describe the

Findings from the Medicaid Competition Demonstrations: A guide for States

PubMed Central

Heinen, LuAnn; Fox, Peter D.; Anderson, Maren D.

1990-01-01

The Medicaid Competition Demonstrations were initiated in 1983-84 in six States (California, Florida, Minnesota, Missouri, New Jersey, and New York). State experiences in implementing the demonstrations are presented in this article. Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance. Therefore, States considering similar programs in the future could benefit from these findings. PMID:10113403

Philanthropy and Beyond: Creating Shared Value to Promote Well-Being for Individuals in Their Communities

PubMed Central

Kottke, Thomas E; Pronk, Nico; Zinkel, Andrew R; Isham, George J

2017-01-01

Health care organizations can magnify the impact of their community service and other philanthropic activities by implementing programs that create shared value. By definition, shared value is created when an initiative generates benefit for the sponsoring organization while also generating societal and community benefit. Because the programs generate benefit for the sponsoring organizations, the magnitude of any particular initiative is limited only by the market for the benefit and not the resources that are available for philanthropy. In this article we use three initiatives in sectors other than health care to illustrate the concept of shared value. We also present examples of five types of shared value programs that are sponsored by health care organizations: telehealth, worksite health promotion, school-based health centers, green and healthy housing, and clean and green health services. On the basis of the innovativeness of health care organizations that have already implemented programs that create shared value, we conclude that the opportunities for all health care organizations to create positive impact for individuals and communities through similar programs is large, and the limits have yet to be defined. PMID:28488982

Evaluation of an antibiotic intravenous to oral sequential therapy program.

PubMed

Pablos, Ana I; Escobar, Ismael; Albiñana, Sandra; Serrano, Olga; Ferrari, José M; Herreros de Tejada, Alberto

2005-01-01

This study was designed to analyse the drug consumption difference and economic impact of an antibiotic sequential therapy focused on quinolones. We studied the consumption of quinolones (ofloxacin/levofloxacin and ciprofloxacin) 6 months before and after the implementation of a sequential therapy program in hospitalised patients. It was calculated for each antibiotic, in its oral and intravenous forms, in defined daily dose (DDD/100 stays per day) and economical terms (drug acquisition cost). At the beginning of the program ofloxacin was replaced by levofloxacin and, since their clinical uses are similar, the consumption of both drugs was compared during the period. In economic terms, the consumption of intravenous quinolones decreased 60% whereas the consumption of oral quinolones increased 66%. In DDD/100 stays per day, intravenous forms consumption decreased 53% and oral forms consumption increased 36%. Focusing on quinolones, the implementation of a sequential therapy program based on promoting an early switch from intravenous to oral regimen has proved its capacity to alter the utilisation profile of these antibiotics. The program has permitted the hospital a global saving of 41420 dollars for these drugs during the period of time considered. Copyright (c) 2004 John Wiley & Sons, Ltd.

First Steps Toward Exploring NITARP's Impacts on Teachers' Knowledge, Attitudes, and Teaching

NASA Astrophysics Data System (ADS)

French, Debbie; Slater, T. F.; Burrows, A. C.

2013-06-01

Few high school science teachers have had opportunities to engage in authentic scientific research. As a result, many may find it difficult to communicate to their students how science is done. Moreover, without relevant experience, teachers have few pathways to be able to successfully implement scientific research and inquiry into the classroom. In response, astronomers created the NASA-IPAC Teacher Archive Research Program - NITARP, originally funded by NASA as part of the Spitzer Space Telescope Public Engagement Program, and more recently as an NSF-sponsored Research Experience for Teachers program (NSF 0742222). This project partners teachers and their students with a mentor scientist to work on a unique research project using Spitzer Space Telescope data. The year-long project culminates by having teachers and students present their scientific methods and findings at a professional conference, such as the American Astronomical Society. To determine how teachers’ attitudes toward science and scientific inquiry changed after participating in NITARP, five NITARP alumni teachers completed open-ended survey and interview questions describing how their experience changed how they thought about astronomy and what happened in their classroom as a direct result of their NITARP experiences. Teachers reported increasing their astronomy content knowledge, implementing new skills and computer programs into their curriculum, incorporating the use of real data, and are implementing, or are planning to implement research in their classrooms. Teachers also stated they feel more comfortable speaking the language of science and communicating with scientists. They also felt more confident in teaching how science is done. The results of this exploratory study showing positive impacts motivate us to more deeply study the underlying mechanisms in this and similar programs best poised to improve science education.

Dissemination of Technology to Evaluate Healthy Food Incentive Programs.

PubMed

Freedman, Darcy A; Hunt, Alan R; Merritt, Katie; Shon, En-Jung; Pike, Stephanie N

2017-03-01

Federal policy supports increased implementation of monetary incentive interventions for chronic disease prevention among low-income populations. This study describes how a Prevention Research Center, working with a dissemination partner, developed and distributed technology to support nationwide implementation and evaluation of healthy food incentive programming focused on Supplemental Nutrition Assistance Program recipients. FM Tracks, an iOS-based application and website, was developed to standardize evaluation methods for healthy food incentive program implementation at direct-to-consumer markets. This evaluation examined diffusion and adoption of the technology over 9 months (July 2015-March 2016). Data were analyzed in 2016. FM Tracks was disseminated to 273 markets affiliated with 37 regional networks in 18 states and Washington, DC. All markets adopted the sales transaction data collection feature, with nearly all recording at least one Supplemental Nutrition Assistance Program (99.3%) and healthy food incentive (97.1%) transaction. A total of 43,493 sales transactions were recorded. By the ninth month of technology dissemination, markets were entering individual sales transactions using the application (34.5%) and website (29.9%) and aggregated transactions via website (35.6%) at similar rates. Use of optional evaluation features like recording a customer ID with individual transactions increased successively with a low of 22.2% during the first month to a high of 69.2% in the ninth month. Systematic and widely used evaluation technology creates possibilities for pragmatic research embedded within ongoing, real-world implementation of food access interventions. Technology dissemination requires supportive technical assistance and continuous refinement that can be advanced through academic-practitioner partnerships. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Preparation for practice in family medicine: before and after duty hours.

PubMed

Carek, Peter J; Diaz, Vanessa; Dickerson, Lori M; Peterson, Lars; Johnson, Sharleen

2012-09-01

In July of 2003, the Accreditation Council for Graduate Medical Education (ACGME) adopted requirements limiting the duty hours of resident physicians. The impact of these restrictions on education and patient care activities is not clear. The purpose of this study is to examine the perception of graduates of family medicine residency programs immediately prior to and following implementation of duty hours regarding preparedness to practice and board certification status, as well as current patient care activities. Surveys of graduates of family medicine residency programs in South Carolina were conducted. Preparation for practice and professional activities of program graduates prior to (1999--2003) and following (2005--2009) implementation of duty hours were compared. Response rates were 54.4% and 53.1%, respectively. No significant differences by survey years in the average age, gender, or race was noted. Recent graduates felt as well prepared for practice in most curricular areas except surgery (OR=0.50 [0.27, 0.91]) and performed similar procedures with the following exceptions: central line placement (OR=0.32 [0.11, 0.95]), flexible sigmoidoscopy (OR=0.12 [0.02, 0.80]), ICU care (OR=0.39 [0.22, 0.70]), and ventilator management (OR=0.54 [0.29, 0.99]). Higher proportion of recent graduates do not take after hours call (22.3% versus 8.6%). Similarly, fewer recent graduates care for patients in nursing homes (22.0% versus 44.9%) and hospitals (46.2% versus 68.0%). Implementation of resident duty hours appears to have little overall association with self-reported preparedness for practice. An association was noted in the patient care services and procedures performed.

Gemini Observatory Takes its Local Communities on an Expanding Journey

NASA Astrophysics Data System (ADS)

Harvey, Janice; Michaud, Peter

2012-08-01

Currently in its 7th year (2011) Hawaii's annual Journey through the Universe (JttU) program is a flagship Gemini Observatory public education/outreach initiative involving a broad cross-section of the local Hawai'i Island astronomical community, the public, educators, businesses, local government officials, and thousands of local students. This paper describes the program, its history, planning, implementation, as well as the program's objectives and philosophy. The success of this program is documented here, as measured by continuous and expanding engagement of educators, the community, and the public, along with formal evaluation feedback and selected informal verbal testimony. The program's success also serves as justification for the planned adaptation of a version of the program in Chile in 2011 (adapted for Chilean educational and cultural differences). Finally, lessons learned are shared which have refined the program for Gemini's host communities but can also apply to any institution wishing to initiate a similar program.

California Publicly-Owned Utilities (POUs) – LBNL ‘Beyond Widgets’ Project. Task: ambient lighting and occupancy-based plug load control. System Program Manual

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robinson, Alastair; Mathew, Paul A.; Regnier, Cynthia

This program manual contains detailed technical information for implementing an incentive program for task-ambient lighting and occupancy-based plug load control. This manual was developed by Lawrence Berkeley National Laboratory, in collaboration with the California Publicly-Owned Utilities (CA POUs) as a partner in the ‘Beyond Widgets’ program funded by the U.S. Department of Energy Building Technologies Office. The primary audience for this manual is the program staff of the various CA POUs. It may also be used by other utility incentive programs to help develop similar programs. It is anticipated that the content of this manual be utilized by the CAmore » POU staff for developing related documents such as the Technical Resource Manual and other filings pertaining to the rollout of an energy systems-based rebate incentive program.« less

Enhanced Recovery Pathway in Microvascular Autologous Tissue-Based Breast Reconstruction: Should It Become the Standard of Care?

PubMed

Kaoutzanis, Christodoulos; Ganesh Kumar, Nishant; O'Neill, Dillon; Wormer, Blair; Winocour, Julian; Layliev, John; McEvoy, Matthew; King, Adam; Braun, Stephane A; Higdon, K Kye

2018-04-01

Enhanced recovery pathway programs have demonstrated improved perioperative care and shorter length of hospital stay in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue-based breast reconstruction before and after the implementation of an enhanced recovery pathway program. The authors retrospectively reviewed consecutive patients who underwent autologous tissue-based breast reconstruction performed by two surgeons before and after the implementation of the enhanced recovery pathway at a university center over a 3-year period. Patient demographics, perioperative data, and 45-day postoperative outcomes were compared between the traditional standard of care (pre-enhanced recovery pathway) and enhanced recovery pathway patients. Multivariate logistic regression was performed to identify risk factors for length of hospital stay. Cost analysis was performed. Between April of 2014 and January of 2017, 100 consecutive women were identified, with 50 women in each group. Both groups had similar demographics, comorbidities, and reconstruction types. Postoperatively, the enhanced recovery pathway cohort used significantly less opiate and more acetaminophen compared with the traditional standard of care cohort. Median length of stay was shorter in the enhanced recovery pathway cohort, which resulted in an extrapolated $279,258 savings from freeing up inpatient beds and increase in overall contribution margins of $189,342. Participation in an enhanced recovery pathway program and lower total morphine-equivalent use were independent predictors for decreased length of hospital stay. Overall 45-day major complication rates, partial flap loss rates, emergency room visits, hospital readmissions, and unplanned reoperations were similar between the two groups. Enhanced recovery pathway program implementation should be considered as the standard approach for perioperative care in autologous tissue-based breast reconstruction because it does not affect morbidity and is associated with accelerated recovery with reduced postoperative opiate use and decreased length of hospital stay, leading to downstream health care cost savings. Therapeutic, III.

Interns Addressing Mental Health Needs: Implementation of a Social and Emotional Education Program

ERIC Educational Resources Information Center

Fede, Jessica L.; Solomon, Benjamin G.; Whitcomb, Sara A.

2011-01-01

The estimated prevalence of one or more mental health disorders among children and adolescents between the ages of 9 and 17 is 21% (Satcher, 2001). Similarly, research by Greenberg et al., (2003) estimated that 20% of school-age youth experience mental health problems during the course of any school year. Despite these high prevalence rates, the…

Attic or Roof? An Evaluation of Two Advanced Weatherization Packages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Neuhauser, Ken

2012-06-01

This project examines implementation of advanced retrofit measures in the context of a large-scale weatherization program and the archetypal Chicago brick bungalow. One strategy applies best practice air sealing methods and a standard insulation method to the attic floor. The other strategy creates an unvented roof assembly using materials and methods typically available to weatherization contractors. Through implementations of the retrofit strategies in a total of eight (8) test homes, the research found that the two different strategies achieve similar reductions in air leakage measurement (55%) and predicted energy performance (18%) relative to the pre-retrofit conditions.

Computer program documentation: ISOCLS iterative self-organizing clustering program, program C094

NASA Technical Reports Server (NTRS)

Minter, R. T. (Principal Investigator)

1972-01-01

The author has identified the following significant results. This program implements an algorithm which, ideally, sorts a given set of multivariate data points into similar groups or clusters. The program is intended for use in the evaluation of multispectral scanner data; however, the algorithm could be used for other data types as well. The user may specify a set of initial estimated cluster means to begin the procedure, or he may begin with the assumption that all the data belongs to one cluster. The procedure is initiatized by assigning each data point to the nearest (in absolute distance) cluster mean. If no initial cluster means were input, all of the data is assigned to cluster 1. The means and standard deviations are calculated for each cluster.

Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania.

PubMed

Chaudhury, Sumona; Arlington, Lauren; Brenan, Shelby; Kairuki, Allan Kaijunga; Meda, Amunga Robson; Isangula, Kahabi G; Mponzi, Victor; Bishanga, Dunstan; Thomas, Erica; Msemo, Georgina; Azayo, Mary; Molinier, Alice; Nelson, Brett D

2016-12-01

Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.

Perspectives in medical education 7. Observations on clinical training at a "US-style" residency program at Teine Keijinkai Hospital in Sapporo, Japan.

PubMed

Rao, R Harsha

2009-06-01

The residency program at Teine Keijinkai Hospital in Sapporo has successfully implemented a training philosophy that is focused on the development of clinical skills and critical thinking in Japanese residents. Several elements contribute to its success. The first and foremost is visionary physician leadership, beginning with the pioneers who implemented the philosophy, and continuing through the current leadership, which has sustained the original vision. A close second is the administrative and financial commitment to invest in producing more clinically accomplished Japanese physicians, long before that need was officially recognized. Third is the program's explicit aim of adhering to international norms by requiring three years of training, promulgating a benevolent, not paternalistic teaching philosophy and encouraging an interactive and interrogatory learning ethic. Fourth is the year-round presence of a US-trained Physician-in-Residence, to sustain the focus on clinical skills and international norms. Fifth is a long-term relationship with the Internal Medicine Training Program at the University of Pittsburgh, providing a conduit for ongoing academic exchange and programmatic advice. Last, but not least, is its avowed intention of being viewed as an "American-style program" with a preference for English fluent applicants, which acts as a magnet for trainees motivated to acquire clinical skills and competencies, with an eye to future training in the US. All these elements contribute to the program's unique focus on teaching clinical skills and critical thinking. Others who are striving with varying degrees of success to implement a similar philosophy in Japan may benefit from studying its example.

The critical role of social workers in home-based primary care.

PubMed

Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

2014-01-01

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

Teacher change and professional development: A case study of teachers engaged in an innovative constructivist science curriculum

NASA Astrophysics Data System (ADS)

Akura, Okong'o. Gabriel

This study examined both the changes that elementary school teachers experienced when they implemented a reform-based science curriculum and the impact of professional development on this transformation. The research involved a case study of three purposefully selected teachers implementing the Linking Food and the Environment (LIFE) program during the 2002--2003 school year. The LIFE program is a curriculum designed to enhance science literacy among learners from high poverty urban environments. While the study was grounded in the tradition of critical theory (Carspecken, 1996), the theoretical perspective of hermeneutic phenomenology (van Manen, 1990) guided data collection and analysis. Extensive observations of the teachers were made in order to capture and record the teacher change phenomenon. Data were recorded by means of field notes, audio and videotapes, semi-structured interviews, classroom observations, and video Stimulated Recall (SR) interviews. Emerging themes relating to teacher change, knowledge interests, constructivist pedagogy, and professional development illustrated how teachers grapple with various aspects of implementing a reform-based science curriculum. The teachers in this study were similar to those in earlier investigations, which found that sustained professional development programs involving mentoring and constant reflection enable elementary science teachers to change their instructional strategies from the technical-realist orientation towards the practical-hermeneutic and emancipatory-liberatory orientations. The study has implications for science curriculum developers and designers of professional development programs.

Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

PubMed

Sanchez, Iris

2011-01-01

The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

Family predictors of parent participation in an adolescent drug abuse prevention program.

PubMed

Al-Halabi Díaz, Susana; Secades-Villa, Roberto; Pérez, José Manuel Errasti; Fernández-Hermida, José Ramón; García-Rodríguez, Olaya; Crespo, José Luis Carballo

2006-07-01

Low participation rates constitute a serious problem faced by family drug abuse prevention programs. In this study we analyse the factors related to participation in a Life Skills Training program implemented in three schools in Spain. Participants in the study were 485 pupils aged 12 - 14 years and their respective parents. The variables that predicted participation in the program were: number of children and educational level of parents, children's drug use, family conflict, parental rearing style, relationships between parents and children and family communication. The results from Spain are similar to those found in international studies, and indicate that the families most at risk of drug use are those least likely to participate in prevention programs. There is a need for strategies to increase participation in prevention programs of the families most at risk.

Management strategies for trace organic chemicals in water - A review of international approaches.

PubMed

Bieber, Stefan; Snyder, Shane A; Dagnino, Sonia; Rauch-Williams, Tanja; Drewes, Jörg E

2018-03-01

To ensure an appropriate management of potential health risks and uncertainties from the release of trace organic chemicals (TOrCs) into the aqueous environment, many countries have evaluated and implemented strategies to manage TOrCs. The aim of this study was to evaluate existing management strategies for TOrCs in different countries to derive and compare underlying core principles and paradigms and to develop suggestions for more holistic management strategies to protect the environment and drinking water supplies from the discharge of undesired TOrCs. The strategies in different industrial countries were summarized and subsequently compared with regards to three particular questions: 1) Do the approaches different countries have implemented manage all or only specific portions of the universe of chemicals; 2) What implementation and compliance strategies are used to manage aquatic and human health risk and what are their pros and cons; and 3) How are site-specific watershed differences being addressed? While management strategies of the different countries target similar TOrCs, the programs differ in several important aspects, including underlying principles, the balance between aquatic or human health protection, implementation methods, and financing mechanisms used to fund regulatory programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

"Current topics in health sciences librarianship": a pilot program for network-based lifelong learning.

PubMed Central

Brandt, K A; Sapp, J R; Campbell, J M

1996-01-01

The long-term objective of this project is to make health sciences librarians more effective in their role by using emerging technologies to deliver timely continuing education (CE) programs to them regardless of their physical location. The goals of the one-year planning project at the William H. Welch Medical Library are to plan, implement, and evaluate a pilot CE program that includes (1) a three-day general-interest session organized in four tracks: Market Forces and Management, Information Technology and the Internet, Publishing and Copyright, and Education; (2) a one-day special topic session on the Informatics of the Human Genome Project; and (3) an electronic poster session in parallel with the general-interest session. The program will be offered in three simultaneous formats: (1) on-site, in a distance-learning classroom in Baltimore; (2) as a telecourse, in a similar classroom outside Washington, DC; and (3) online, via the World Wide Web. An electronic proceedings of the entire program will be published on the Web to serve as a continuously available CE resource for health sciences librarians. This paper gives an overview of the planning process, presents a status report on the programmatic and technical implementation of the pilot project at its midpoint, and discusses future directions for the program. PMID:8913554

Implementing embedded artificial intelligence rules within algorithmic programming languages

NASA Technical Reports Server (NTRS)

Feyock, Stefan

1988-01-01

Most integrations of artificial intelligence (AI) capabilities with non-AI (usually FORTRAN-based) application programs require the latter to execute separately to run as a subprogram or, at best, as a coroutine, of the AI system. In many cases, this organization is unacceptable; instead, the requirement is for an AI facility that runs in embedded mode; i.e., is called as subprogram by the application program. The design and implementation of a Prolog-based AI capability that can be invoked in embedded mode are described. The significance of this system is twofold: Provision of Prolog-based symbol-manipulation and deduction facilities makes a powerful symbolic reasoning mechanism available to applications programs written in non-AI languages. The power of the deductive and non-procedural descriptive capabilities of Prolog, which allow the user to describe the problem to be solved, rather than the solution, is to a large extent vitiated by the absence of the standard control structures provided by other languages. Embedding invocations of Prolog rule bases in programs written in non-AI languages makes it possible to put Prolog calls inside DO loops and similar control constructs. The resulting merger of non-AI and AI languages thus results in a symbiotic system in which the advantages of both programming systems are retained, and their deficiencies largely remedied.

Evaluation of a model training program for respiratory-protection preparedness at local health departments.

PubMed

Alfano-Sobsey, Edie; Kennedy, Bobby; Beck, Frank; Combs, Brian; Kady, Wendy; Ramsey, Steven; Stockweather, Allison; Service, Will

2006-04-01

Respiratory-protection programs have had limited application in local health departments and have mostly focused on protecting employees against exposure to tuberculosis (TB). The need to provide the public health workforce with effective respiratory protection has, however, been underscored by recent concerns about emerging infectious diseases, bioterrorism attacks, drug-resistant microbes, and environmental exposures to microbial allergens (as in recent hurricane flood waters). Furthermore, OSHA has revoked the TB standard traditionally followed by local health departments, replacing it with a more stringent regulation. The additional OSHA requirements may place increased burdens on health departments with limited resources and time. For these reasons, the North Carolina Office of Public Health Preparedness and Response and industrial hygienists of the Public Health Regional Surveillance Teams have developed a training program to facilitate implementation of respiratory protection programs at local health departments. To date, more than 1,400 North Carolina health department employees have been properly fit-tested for respirator use and have received training in all aspects of respiratory protection. This article gives an overview of the development and evaluation of the program. The training approach presented here can serve as a model that other health departments and organizations can use in implementing similar respiratory-protection programs.

The improving efficiency frontier of inpatient rehabilitation hospitals.

PubMed

Harrison, Jeffrey P; Kirkpatrick, Nicole

2011-01-01

This study uses a linear programming technique called data envelopment analysis to identify changes in the efficiency frontier of inpatient rehabilitation hospitals after implementation of the prospective payment system. The study provides a time series analysis of the efficiency frontier for inpatient rehabilitation hospitals in 2003 immediately after implementation of PPS and then again in 2006. Results indicate that the efficiency frontier of inpatient rehabilitation hospitals increased from 84% in 2003 to 85% in 2006. Similarly, an analysis of slack or inefficiency shows improvements in output efficiency over the study period. This clearly documents that efficiency in the inpatient rehabilitation hospital industry after implementation of PPS is improving. Hospital executives, health care policymakers, taxpayers, and other stakeholders benefit from studies that improve health care efficiency.

X-Windows PVT Widget Class

NASA Technical Reports Server (NTRS)

Barry, Matthew R.

2006-01-01

The X-Windows Process Validation Table (PVT) Widget Class ( Class is used here in the object-oriented-programming sense of the word) was devised to simplify the task of implementing network registration services for Information Sharing Protocol (ISP) graphical-user-interface (GUI) computer programs. Heretofore, ISP PVT programming tasks have required many method calls to identify, query, and interpret the connections and messages exchanged between a client and a PVT server. Normally, programmers have utilized direct access to UNIX socket libraries to implement the PVT protocol queries, necessitating the use of many lines of source code to perform frequent tasks. Now, the X-Windows PVT Widget Class encapsulates ISP client server network registration management tasks within the framework of an X Windows widget. Use of the widget framework enables an X Windows GUI program to interact with PVT services in an abstract way and in the same manner as that of other graphical widgets, making it easier to program PVT clients. Wrapping the PVT services inside the widget framework enables a programmer to treat a PVT server interface as though it were a GUI. Moreover, an alternate subclass could implement another service in a widget of the same type. This program was written by Matthew R. Barry of United Space Alliance for Johnson Space Center. For further information, contact the Johnson Technology Transfer Office at (281) 483-3809. MSC-23582 Shuttle Data Center File- Processing Tool in Java A Java-language computer program has been written to facilitate mining of data in files in the Shuttle Data Center (SDC) archives. This program can be executed on a variety of workstations or via Web-browser programs. This program is partly similar to prior C-language programs used for the same purpose, while differing from those programs in that it exploits the platform-neutrality of Java in implementing several features that are important for analysis of large sets of time-series data. The program supports regular expression queries of SDC archive files, reads the files, interleaves the time-stamped samples according to a chosen output, then transforms the results into that format. A user can choose among a variety of output file formats that are useful for diverse purposes, including plotting, Markov modeling, multivariate density estimation, and wavelet multiresolution analysis, as well as for playback of data in support of simulation and testing.

Comprehensive Hearing Aid Intervention at a Free Subspecialty Clinic.

PubMed

Wertz, Aileen P; Mannarelli, Gregory; Shuman, Andrew G; McKean, Erin L

2017-09-01

Providing a model of a comprehensive free audiologic program may assist other health care professionals in developing their own similar program. To describe the structure, feasibility, and outcomes of a free subspecialty clinic providing hearing aids to develop a paradigm for other programs interested in implementing similar projects. A retrospective case series was conducted from September 1, 2013, through March 31, 2016. In a partnership between a free independent clinic for indigent patients and an academic medical center, 54 indigent patients were referred to the clinic for audiograms. A total of 50 of these patients had results of audiograms available for review and were therefore included in the study; 34 of these 50 patients were determined to be eligible for hearing aid fitting based on audiometric results. Free audiometric testing, hearing aid fitting, and hearing aid donation. The number of hearing aids donated, number of eligible patients identified, number of patients fitted with hearing aids, and work effort (hours) and start-up costs associated with implementation of this program were quantified. A total of 54 patients (31 women [57.4%] and 23 men [42.6%]; median age, 61 years; range, 33-85 years) had audiograms performed, and 84 hearing aids were donated to the program. The patients were provided with free audiograms, hearing aid molds, and hearing aid programming, as well as follow-up appointments to ensure continued proper functioning of their hearing aids. Since 2013, a total of 34 patients have been determined to be eligible for the free program and were offered hearing aid services. Of these, 20 patients (59%) have been fitted or are being fitted with free hearing aids. The value of services provided is estimated to be $2260 per patient. It is feasible to provide free, comprehensive audiologic care, including hearing aids and fitting, in a well-established, free clinic model. The opportunity for indigent patients to use hearing aids at minimal personal cost is a major step forward in improving access to high-quality care.

Implementation of a reimbursed medication review program: Corporate and pharmacy level strategies.

PubMed

MacKeigan, Linda D; Ijaz, Nadine; Bojarski, Elizabeth A; Dolovich, Lisa

In 2006, the Ontario drug plan greatly reduced community pharmacy reimbursement for generic drugs. In exchange, a fee-for-service medication review program was introduced to help patients better understand their medication therapy and ensure that medications were taken as prescribed. A qualitative study of community pharmacy implementation strategies was undertaken to inform a mixed methods evaluation of the program. To describe strategies used by community pharmacies to implement a government-funded medication review service. Key informant interviews were conducted with pharmacy corporate executives and managers, as well as independent pharmacy owners. All pharmacy corporations in the province were approached; owners were purposively sampled from the registry of the pharmacist licensing body to obtain diversity in pharmacy attributes; and pharmacy managers were identified through a mix of snowball and registry sampling. Thematic qualitative coding and analysis were applied to interview transcripts. 42 key informants, including 14 executives, 15 managers/franchisees, and 11 owners, participated. The most common implementation strategy was software adaptation to flag eligible patients and to document the service. Human resource management (task shifting to technicians and increasing the technician complement), staff training, and patient identification and recruitment processes were widely mentioned. Motivational strategies including service targets and financial incentives were less frequent but controversial. Strategies typically unfolded over time, and became multifaceted. Apart from the use of targets in chain pharmacies only, strategies were similar across pharmacy ownership types. Ontario community pharmacies appeared to have done little preplanning of implementation strategies. Strategies focused on service efficiency and quantity, rather than quality. Unlike other jurisdictions, many managers supported the use of targets as motivators, and very few reported feeling pressured. This detailed account of a range of implementation strategies may be of practical value to community pharmacy decision makers. Copyright © 2017 Elsevier Inc. All rights reserved.

Unintended adverse consequences of electronic health record introduction to a mature universal HIV screening program.

PubMed

Medford-Davis, Laura N; Yang, Katharine; Pasalar, Siavash; Pillow, M Tyson; Miertschin, Nancy P; Peacock, William F; Giordano, Thomas P; Hoxhaj, Shkelzen

2016-01-01

Early HIV detection and treatment decreases morbidity and mortality and reduces high-risk behaviors. Many Emergency Departments (EDs) have HIV screening programs as recommended by the Centers for Disease Control and Prevention. Recent federal legislation includes incentives for electronic health record (EHR) adoption. Our objective was to analyze the impact of conversion to EHR on a mature ED-based HIV screening program. A retrospective pre- and post-EHR implementation cohort study was conducted in a large urban, academic ED. Medical records were reviewed for HIV screening rates from August 2008 through October 2013. On 1 November 2010, a comprehensive EHR system was implemented throughout the hospital. Before EHR implementation, labs were requested by providers by paper orders with HIV-1/2 automatically pre-selected on every form. This universal ordering protocol was not duplicated in the new EHR; rather it required a provider to manually enter the order. Using a chi-squared test, we compared HIV testing in the 6 months before and after EHR implementation; 55,054 patients presented before, and 50,576 after EHR implementation. Age, sex, race, acuity of presenting condition, and HIV seropositivity rates were similar pre- and post-EHR, and there were no major patient or provider changes during this period. Average HIV testing rate was 37.7% of all ED patients pre-, and 22.3% post-EHR, a 41% decline (p < 0.0001), leading to 167 missed new diagnoses after EHR. The rate of HIV screening in the ED decreased after EHR implementation, and could have been improved with more thoughtful inclusion of existing human processes in its design.

Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative.

PubMed

Haynes, Alex B; Edmondson, Lizabeth; Lipsitz, Stuart R; Molina, George; Neville, Bridget A; Singer, Sara J; Moonan, Aunyika T; Childers, Ashley Kay; Foster, Richard; Gibbons, Lorri R; Gawande, Atul A; Berry, William R

2017-12-01

To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program. We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis. Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021). Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.

Developing cancer control capacity in state and local public health agencies.

PubMed

Meissner, H I; Bergner, L; Marconi, K M

1992-01-01

In 1986, the National Cancer Institute began a major grant program to enhance the technical capabilities of public health departments in cancer prevention and control. This effort, commonly referred to as "capacity building" for cancer control, provided funding to support eight State and one local health department. The program focused on developing the knowledge and skills of health department personnel to implement intervention programs in such areas as smoking cessation, diet modification, and breast and cervical cancer screening. The grants ranged from 2 to 5 years in length, with funding of $125,000 to $1.6 million per grant. The total for the program was $7.4 million. While the priorities set for these grants were nominally similar, their capacity building activities in cancer prevention and control evolved into unique interventions reflecting the individual needs and priorities of each State or locality. Their experiences illustrate that technical development for planning, implementing, and evaluating cancer prevention and control programs is a complex process that must occur at multiple levels, regardless of overall approach. Factors found to contribute to successful implementation of technical development programs include* commitment of the organization's leadership to provide adequate support for staff and activities and to keep cancer prevention and control on the organizational agenda,* the existence of appropriate data to monitor and evaluate programs,* appropriately trained staff,* building linkages with State and community agencies and coalitions to guide community action,* an established plan or process for achieving cancer control objectives,* access to the advice of and participation of individual cancer and health experts,* an informed State legislature,* diffusion of cancer prevention and control efforts,and* the ability to obtain funds needed for future activities.

Shuttle Data Center File-Processing Tool in Java

NASA Technical Reports Server (NTRS)

Barry, Matthew R.; Miller, Walter H.

2006-01-01

A Java-language computer program has been written to facilitate mining of data in files in the Shuttle Data Center (SDC) archives. This program can be executed on a variety of workstations or via Web-browser programs. This program is partly similar to prior C-language programs used for the same purpose, while differing from those programs in that it exploits the platform-neutrality of Java in implementing several features that are important for analysis of large sets of time-series data. The program supports regular expression queries of SDC archive files, reads the files, interleaves the time-stamped samples according to a chosen output, then transforms the results into that format. A user can choose among a variety of output file formats that are useful for diverse purposes, including plotting, Markov modeling, multivariate density estimation, and wavelet multiresolution analysis, as well as for playback of data in support of simulation and testing.

Development of a community cancer education program: the Forsyth County, NC cervical cancer prevention project.

PubMed

Michielutte, R; Dignan, M B; Wells, H B; Young, L D; Jackson, D S; Sharp, P C

1989-01-01

The authors outline the development and implementation of a public health education program for cervical cancer screening among black women in Forsyth County, NC. The educational program includes distributing electronic and printed information media messages, a program of direct education for women, and providing information on current issues in cervical screening to primary-care physicians. Program development was based on social marketing principles, the PRECEDE model, and the communication-behavior change (CBC) model. Since a true experimental design was not feasible, program evaluation is based on several complementary quasi-experimental designs. Analysis of baseline data indicate that the county where the intervention is taking place, and the control county, are similar with respect to both demographic characteristics and the current level of screening activity. Preliminary results indicate that the program has been successful in raising women's level of awareness of cervical cancer and cervical screening.

Identification of gaps for implementation science in the HIV prevention, care and treatment cascade; a qualitative study in 19 districts in Uganda.

PubMed

Bajunirwe, Francis; Tumwebaze, Flora; Abongomera, George; Akakimpa, Denis; Kityo, Cissy; Mugyenyi, Peter N

2016-04-14

Over the last 20 years, countries in sub Saharan Africa have made significant strides in the implementation of programs for HIV prevention, care and treatment. Despite, the significant progress made, many targets set by the United Nations have not been met. There remains a large gap between the ideal and what has been achieved. There are several operational issues that may be responsible for this gap, and these need to be addressed in order to achieve the targets. Therefore, the aim of this study was to identify gaps in the HIV prevention, care and treatment cascade, in a large district based HIV implementation program. We aimed to identify gaps that are amenable for evaluation using implementation science, in order to improve the delivery of HIV programs in rural Uganda. We conducted key informant (KI) interviews with 60 district health officers and managers of HIV/AIDS clinics and organizations and 32 focus group discussions with exit clients seeking care and treatment for HIV in the 19 districts. The data analysis process was guided using a framework approach. The recordings were transcribed verbatim. Transcripts were read back and forth and codes generated based on the framework. Nine emerging themes that comprise the gaps were identified and these were referral mechanisms indicating several loop holes, low levels of integration of HIV/TB services, low uptake of services for PMTCT services by pregnant women, low coverage of services for most at risk populations (MARPs), poor HIV coordination structures in the districts, poor continuity in the delivery of pediatric HIV/AIDS services, limited community support for orphans and vulnerable (OVC's), inadequate home based care services and HIV services and support for discordant couples. The themes indicate there are plenty of gaps that need to be covered and have been ignored by current programs. Our study has identified several gaps and suggested several interventions that should be tested before large scale implementation. The implementation of these programs should be adequately evaluated in order to provide field evidence of effectiveness and replicability in similar areas.

The Gateway Science Workshop Program: Enhancing Student Performance and Retention in the Sciences Through Peer-Facilitated Discussion

NASA Astrophysics Data System (ADS)

Drane, Denise; Smith, H. David; Light, Greg; Pinto, Larry; Swarat, Su

2005-09-01

Minority student attrition and underachievement is a long-standing and widespread concern in higher education. It is especially acute in introductory science courses which are prerequisites for students planning to pursue science-related careers. Poor performance in these courses often results in attrition of minorities from the science fields. This is a particular concern at selective universities where minority students enter with excellent academic credentials but receive lower average grades and have lower retention rates than majority students with similar credentials. This paper reports the first year results of a large scale peer-facilitated workshop program designed to increase performance and retention in Biology, Chemistry, and Physics at a selective research university. After adjusting for grade point average or SAT-Math score, workshop participants earned higher final grades than nonparticipants in Biology and Chemistry, but not in Physics. Similar effects on retention were found. While, positive effects of the program were observed in both majority and minority students, effect sizes were generally largest for minority students. Because of practical constraints in Physics, implementation of the program was not optimal, possibly accounting for the differential success of the program across disciplines.

Helping the Noncompliant Child: An Assessment of Program Costs and Cost-Effectiveness.

PubMed

Honeycutt, Amanda A; Khavjou, Olga A; Jones, Deborah J; Cuellar, Jessica; Forehand, Rex L

2015-02-01

Disruptive behavior disorders (DBD) in children can lead to delinquency in adolescence and antisocial behavior in adulthood. Several evidence-based behavioral parent training (BPT) programs have been created to treat early onset DBD. This paper focuses on one such program, Helping the Noncompliant Child (HNC), and provides detailed cost estimates from a recently completed pilot study for the HNC program. The study also assesses the average cost-effectiveness of the HNC program by combining program cost estimates with data on improvements in child participants' disruptive behavior. The cost and effectiveness estimates are based on implementation of HNC with low-income families. Investigators developed a Microsoft Excel-based costing instrument to collect data from therapists on their time spent delivering the HNC program. The instrument was designed using an activity-based costing approach, where each therapist reported program time by family, by date, and for each skill that the family was working to master. Combining labor and non-labor costs, it is estimated that delivering the HNC program costs an average of $501 per family from a payer perspective. It also costs an average of $13 to improve the Eyberg Child Behavior Inventory intensity score by 1 point for children whose families participated in the HNC pilot program. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs. These cost estimates are the first to be collected systematically and prospectively for HNC. Program managers may use these estimates to plan for the resources needed to fully implement HNC.

A software methodology for compiling quantum programs

NASA Astrophysics Data System (ADS)

Häner, Thomas; Steiger, Damian S.; Svore, Krysta; Troyer, Matthias

2018-04-01

Quantum computers promise to transform our notions of computation by offering a completely new paradigm. To achieve scalable quantum computation, optimizing compilers and a corresponding software design flow will be essential. We present a software architecture for compiling quantum programs from a high-level language program to hardware-specific instructions. We describe the necessary layers of abstraction and their differences and similarities to classical layers of a computer-aided design flow. For each layer of the stack, we discuss the underlying methods for compilation and optimization. Our software methodology facilitates more rapid innovation among quantum algorithm designers, quantum hardware engineers, and experimentalists. It enables scalable compilation of complex quantum algorithms and can be targeted to any specific quantum hardware implementation.

Deployment Pulmonary Health

DTIC Science & Technology

2015-02-11

A similar risk-based approach may be appropriate for deploying military personnel. e) If DoD were to consider implementing a large- scale pre...quality of existing spirometry programs prior to considering a larger scale pre-deployment effort. Identifying an accelerated decrease in spirometry...baseline spirometry on a wider scale . e) Conduct pre-deployment baseline spirometry if there is a significant risk of exposure to a pulmonary hazard based

Continued Development of Expert System Tools for NPSS Engine Diagnostics

NASA Technical Reports Server (NTRS)

Lewandowski, Henry

1996-01-01

The objectives of this grant were to work with previously developed NPSS (Numerical Propulsion System Simulation) tools and enhance their functionality; explore similar AI systems; and work with the High Performance Computing Communication (HPCC) K-12 program. Activities for this reporting period are briefly summarized and a paper addressing the implementation, monitoring and zooming in a distributed jet engine simulation is included as an attachment.

Connecticut's Value-Based Insurance Plan Increased The Use Of Targeted Services And Medication Adherence.

PubMed

Hirth, Richard A; Cliff, Elizabeth Q; Gibson, Teresa B; McKellar, M Richard; Fendrick, A Mark

2016-04-01

In 2011 Connecticut implemented the Health Enhancement Program for state employees. This voluntary program followed the principles of value-based insurance design (VBID) by lowering patient costs for certain high-value primary and chronic disease preventive services, coupled with requirements that enrollees receive these services. Nonparticipants in the program, including those removed for noncompliance with its requirements, were assessed a premium surcharge. The program was intended to curb cost growth and improve health through adherence to evidence-based preventive care. To evaluate its efficacy in doing so, we compared changes in service use and spending after implementation of the program to trends among employees of six other states. Compared to employees of other states, Connecticut employees were similar in age and sex but had a slightly higher percentage of enrollees with chronic conditions and substantially higher spending at baseline. During the program's first two years, the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased, relative to the situation in the comparison states. The program's impact on costs was inconclusive and requires a longer follow-up period. This novel combination of VBID principles and participation requirements may be a tool that can help plan sponsors increase the use of evidence-based preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

Does Skin in the Game Matter if You Aren't Playing? Examining Participation in Oregon's Public Employee Health Engagement Model.

PubMed

Wright, Bill J; Dulacki, Kristen; Rissi, Jill; McBride, Leslie; Tran, Sarah; Royal, Natalie

2017-01-01

Employers are increasingly exploring health benefits that incentivize lifestyle change for employees. We used early data from an ongoing study of one such model-the Health Engagement Model (HEM), which Oregon implemented for all public employees in 2012-to analyze variation in employee participation and engagement. A survey was designed to assess program engagement, opinions of the program, and self-reported lifestyle changes. Data were collected in 2012, about 9 months after HEM launched. A representative random sample of 4500 state employees served as the study subjects. Primary measures included whether employees signed up for the program, completed its required activities, and reported making lifestyle changes. Logistic regression was used to analyze survey results. Most employees (86%) chose to participate, but there were important socioeconomic differences: some key target populations, including smokers and obese employees, were the least likely to sign up; less educated employees were also less likely to complete program activities. Despite mostly negative opinions of the program, almost half of participants reported making lifestyle changes. Oregon's HEM launch was largely unpopular with employees, but many reported making the desired lifestyle changes. However, some of those the program is most interested in enrolling were the least likely to engage. People involved with implementing similar programs will need to think carefully about how to cultivate broad interest among employees.

Stakeholders' contributions to tailored implementation programs: an observational study of group interview methods.

PubMed

Huntink, Elke; van Lieshout, Jan; Aakhus, Eivind; Baker, Richard; Flottorp, Signe; Godycki-Cwirko, Maciek; Jäger, Cornelia; Kowalczyk, Anna; Szecsenyi, Joachim; Wensing, Michel

2014-12-06

Tailored strategies to implement evidence-based practice can be generated in several ways. In this study, we explored the usefulness of group interviews for generating these strategies, focused on improving healthcare for patients with chronic diseases. Participants included at least four categories of stakeholders (researchers, quality officers, health professionals, and external stakeholders) in five countries. Interviews comprised brainstorming followed by a structured interview and focused on different chronic conditions in each country. We compared the numbers and types of strategies between stakeholder categories and between interview phases. We also determined which strategies were actually used in tailored intervention programs. In total, 127 individuals participated in 25 group interviews across five countries. Brainstorming generated 8 to 120 strategies per group; structured interviews added 0 to 55 strategies. Healthcare professionals and researchers provided the largest numbers of strategies. The type of strategies for improving healthcare practice did not differ systematically between stakeholder groups in four of the five countries. In three out of five countries, all components of the chosen intervention programs were mentioned by the group of researchers. Group interviews with different stakeholder categories produced many strategies for tailored implementation of evidence-based practice, of which the content was largely similar across stakeholder categories.

Strategic bombers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-07-01

This paper reports on the questions: should Congress provide more funds for the Air Force's current plan---the CORE program---to upgrade the B-1B defense avionics system In GAO's view, more testing of the system is not necessary to determine whether to implement the CORE program. Flight testing has shown that the CORE modifications would provide similar operational capabilities to, and offer some survivability improvements over, the existing defense avionics system. The only reason for additional testing would be to prove that some problems with the maintenance diagnostic system has been resolved. Initial testing revealed that while some improvements were achieved, usermore » requirements were not met for such things as low false alarm rates and cannot duplicate rates. Even if the maintenance diagnostic capabilities were fully demonstrated, however, the CORE system should not be implemented until it is known whether the defense avionics system design can support the B-1B's new role as a conventional bomber.« less

Developing and Implementing a Positive Behavioral Reinforcement Intervention in Prison-Based Drug Treatment: Project BRITE

PubMed Central

Burdon, William M.; De Lore, Jef St.; Prendergast, Michael L.

2012-01-01

Within prison settings, the reliance on punishment for controlling inappropriate or non-compliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention. PMID:22185038

Coordinating an interdisciplinary disease management conference on a military installation: collaboration between military and civilian communities, lessons learned.

PubMed

Lewis-Fleming, Glenda; Knapp, Casey A

2009-08-01

The needs of individuals with chronic diseases or disabilities are similar whether within military or civilian communities. With finite resources and the continuing global war on terrorism, military treatment facilities (MTFs) may find collaborative, multidisciplinary, continuing education efforts with community agencies invaluable. Collaborative efforts that bring military and civilian communities together can result in innovative programs that offer cost-effective high-quality information to enhance the knowledge and skill level of military families, providers, and other professionals who provide services and care for military eligible beneficiaries. This article addresses the development and implementation of two major multidisciplinary disease management conferences at Naval Medical Center Portsmouth (NMCP), Virginia. It provides an overview of lessons learned in the areas of preplanning, team building, program development, implementation, and evaluation. Despite challenges, tremendous benefits may be reaped from efforts to include diverse target populations from military and civilian communities.

Developing and implementing a positive behavioral reinforcement intervention in prison-based drug treatment: Project BRITE.

PubMed

Burdon, William M; St De Lore, Jef; Prendergast, Michael L

2011-09-01

Within prison settings, the reliance on punishment for controlling inappropriate or noncompliant behavior is self-evident. What is not so evident is the similarity between this reliance on punishment and the use of positive reinforcements to increase desired behaviors. However, seldom do inmates receive positive reinforcement for engaging in prosocial behaviors or, for inmates receiving drug treatment, behaviors that are consistent with or support their recovery. This study provides an overview of the development and implementation of a positive behavioral reinforcement intervention in male and female prison-based drug treatment programs. The active involvement of institutional staff, treatment staff, and inmates enrolled in the treatment programs in the development of the intervention along with the successful branding of the intervention were effective at promoting support and participation. However, these factors may also have ultimately impacted the ability of the randomized design to reliably demonstrate the effectiveness of the intervention.

International Review of the Development and Implementation of Energy Efficiency Standards and Labeling Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Nan; Zheng, Nina; Fridley, David

2012-02-28

Appliance energy efficiency standards and labeling (S&L) programs have been important policy tools for regulating the efficiency of energy-using products for over 40 years and continue to expand in terms of geographic and product coverage. The most common S&L programs include mandatory minimum energy performance standards (MEPS) that seek to push the market for efficient products, and energy information and endorsement labels that seek to pull the market. This study seeks to review and compare some of the earliest and most well-developed S&L programs in three countries and one region: the U.S. MEPS and ENERGY STAR, Australia MEPS and Energymore » Label, European Union MEPS and Ecodesign requirements and Energy Label and Japanese Top Runner programs. For each program, key elements of S&L programs are evaluated and comparative analyses across the programs undertaken to identify best practice examples of individual elements as well as cross-cutting factors for success and lessons learned in international S&L program development and implementation. The international review and comparative analysis identified several overarching themes and highlighted some common factors behind successful program elements. First, standard-setting and programmatic implementation can benefit significantly from a legal framework that stipulates a specific timeline or schedule for standard-setting and revision, product coverage and legal sanctions for non-compliance. Second, the different MEPS programs revealed similarities in targeting efficiency gains that are technically feasible and economically justified as the principle for choosing a standard level, in many cases at a level that no product on the current market could reach. Third, detailed survey data such as the U.S. Residential Energy Consumption Survey (RECS) and rigorous analyses provide a strong foundation for standard-setting while incorporating the participation of different groups of stakeholders further strengthen the process. Fourth, sufficient program resources for program implementation and evaluation are critical to the effectiveness of standards and labeling programs and cost-sharing between national and local governments can help ensure adequate resources and uniform implementation. Lastly, check-testing and punitive measures are important forms of enforcement while the cancellation of registration or product sales-based fines have also proven effective in reducing non-compliance. The international comparative analysis also revealed the differing degree to which the level of government decentralization has influenced S&L programs and while no single country has best practices in all elements of standards and labeling development and implementation, national examples of best practices for specific elements do exist. For example, the U.S. has exemplified the use of rigorous analyses for standard-setting and robust data source with the RECS database while Japan's Top Runner standard-setting principle has motivated manufacturers to exceed targets. In terms of standards implementation and enforcement, Australia has demonstrated success with enforcement given its long history of check-testing and enforcement initiatives while mandatory information-sharing between EU jurisdictions on compliance results is another important enforcement mechanism. These examples show that it is important to evaluate not only the drivers of different paths of standards and labeling development, but also the country-specific context for best practice examples in order to understand how and why certain elements of specific S&L programs have been effective.« less

Effects of an emotional intelligence program in variables related to the prevention of violence

PubMed Central

Garaigordobil, Maite; Peña-Sarrionandia, Ainize

2015-01-01

In recent decades, numerous studies have shown a significant increase in violence during childhood and adolescence. These data suggest the importance of implementing programs to prevent and reduce violent behavior. The study aimed to design a program of emotional intelligence (EI) for adolescents and to assess its effects on variables related to violence prevention. The possible differential effect of the program on both genders was also examined. The sample comprised 148 adolescents aged from 13 to 16 years. The study used an experimental design with repeated pretest–posttest measures and control groups. To measure the variables, four assessment instruments were administered before and after the program, as well as in the follow-up phase (1 year after the conclusion of the intervention). The program consisted of 20 one-hour sessions. The pretest–posttest ANCOVAs showed that the program significantly increased: (1) EI (attention, clarity, emotional repair); (2) assertive cognitive social interaction strategies; (3) internal control of anger; and (4) the cognitive ability to analyze negative feelings. In the follow-up phase, the positive effects of the intervention were generally maintained and, moreover, the use of aggressive strategies as an interpersonal conflict-resolution technique was significantly reduced. Regarding the effect of the program on both genders, the change was very similar, but the boys increased assertive social interaction strategies, attention, and emotional clarity significantly more than the girls. The importance of implementing programs to promote socio-emotional development and prevent violence is discussed. PMID:26082743

Effects of an emotional intelligence program in variables related to the prevention of violence.

PubMed

Garaigordobil, Maite; Peña-Sarrionandia, Ainize

2015-01-01

In recent decades, numerous studies have shown a significant increase in violence during childhood and adolescence. These data suggest the importance of implementing programs to prevent and reduce violent behavior. The study aimed to design a program of emotional intelligence (EI) for adolescents and to assess its effects on variables related to violence prevention. The possible differential effect of the program on both genders was also examined. The sample comprised 148 adolescents aged from 13 to 16 years. The study used an experimental design with repeated pretest-posttest measures and control groups. To measure the variables, four assessment instruments were administered before and after the program, as well as in the follow-up phase (1 year after the conclusion of the intervention). The program consisted of 20 one-hour sessions. The pretest-posttest ANCOVAs showed that the program significantly increased: (1) EI (attention, clarity, emotional repair); (2) assertive cognitive social interaction strategies; (3) internal control of anger; and (4) the cognitive ability to analyze negative feelings. In the follow-up phase, the positive effects of the intervention were generally maintained and, moreover, the use of aggressive strategies as an interpersonal conflict-resolution technique was significantly reduced. Regarding the effect of the program on both genders, the change was very similar, but the boys increased assertive social interaction strategies, attention, and emotional clarity significantly more than the girls. The importance of implementing programs to promote socio-emotional development and prevent violence is discussed.

Postgraduate Emergency Medicine Training in India: An Educational Partnership with the Private Sector.

PubMed

Douglass, Katherine; Pousson, Amelia; Gidwani, Shweta; Smith, Jeffrey

2015-11-01

Emergency medicine (EM) is a recently recognized specialty in India, still in its infancy. Local training programs are developing, but remain very limited. Private, for-profit hospitals are an important provider of graduate medical education (GME) in India, and are partnering with United States (US) universities in EM to expand training opportunities. Our aim was to describe current private-sector programs affiliated with a US university providing postgraduate EM training in India, the evolution and structure of these programs, and successes and challenges of program implementation. Programs have been established in seven cities in India in partnership with a US academic institution. Full-time trainees have required didactics, clinical rotations, research, and annual examinations. Faculty members affiliated with the US institution visit each program monthly. Regular evaluations have informed program modifications, and a local faculty development program has been implemented. Currently, 240 trainees are enrolled in the EM postgraduate program, and 141 physicians have graduated. A pilot survey conducted in 2012 revealed that 93% of graduates are currently practicing EM, 82% of those in India; 71% are involved in teaching, and 32% in research. Further investigation into programmatic impacts is necessary. Challenges include issues of formal program recognition both in India and abroad. This unique partnership is playing a major early role in EM GME in India. Future steps include official program recognition, expanded numbers of training sites, and a gradual transition of training and education to local faculty. Similar partnership programs may be effective in other settings outside of India. Copyright © 2015 Elsevier Inc. All rights reserved.

Public/private partnerships for prescription drug coverage: policy formulation and outcomes in Quebec's universal drug insurance program, with comparisons to the Medicare prescription drug program in the United States.

PubMed

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

2007-09-01

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.

Public/Private Partnerships for Prescription Drug Coverage: Policy Formulation and Outcomes in Quebec's Universal Drug Insurance Program, with Comparisons to the Medicare Prescription Drug Program in the United States

PubMed Central

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth

2007-01-01

In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA. PMID:17718665

10 Guiding principles of a comprehensive Internet-based public health preparedness training and education program.

PubMed

Alexander, Lorraine K; Horney, Jennifer A; Markiewicz, Milissa; MacDonald, Pia D M

2010-01-01

Distance learning is an effective strategy to address the many barriers to continuing education faced by the public health workforce. With the proliferation of online learning programs focused on public health, there is a need to develop and adopt a common set of principles and practices for distance learning. In this article, we discuss the 10 principles that guide the development, design, and delivery of the various training modules and courses offered by the North Carolina Center for Public Health Preparedness (NCCPHP). These principles are the result of 10 years of experience in Internet-based public health preparedness educational programming. In this article, we focus on three representative components of NCCPHP's overall training and education program to illustrate how the principles are implemented and help others in the field plan and develop similar programs.

Leveraging Safety Programs to Improve and Support Security Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leach, Janice; Snell, Mark K.; Pratt, R.

2015-10-01

There has been a long history of considering Safety, Security, and Safeguards (3S) as three functions of nuclear security design and operations that need to be properly and collectively integrated with operations. This paper specifically considers how safety programmes can be extended directly to benefit security as part of an integrated facility management programme. The discussion will draw on experiences implementing such a programme at Sandia National Laboratories’ Annular Research Reactor Facility. While the paper focuses on nuclear facilities, similar ideas could be used to support security programmes at other types of high-consequence facilities and transportation activities.

Development and release of phenological data products—A case study in compliance with federal open data policy

USGS Publications Warehouse

Rosemartin, Alyssa H.; Langseth, Madison L.; Crimmins, Theresa M.; Weltzin, Jake F.

2018-01-31

In Autumn 2015, USA National Phenology Network (USA-NPN) staff implemented new U.S. Geological Survey (USGS) data-management policies intended to ensure that the results of Federally funded research are made available to the public. The effort aimed both to improve USA-NPN data releases and to provide a model for similar programs within the USGS. This report provides an overview of the steps taken to ensure compliance, following the USGS Science Data Lifecycle, and provides lessons learned about the data-release process for USGS program leaders and data managers.

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

PubMed Central

2013-01-01

Background Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Objectives Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Study design Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Results Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space. The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. Conclusions The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases. PMID:24010683

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

PubMed

Shaw, Ryan J; Kaufman, Miriam A; Bosworth, Hayden B; Weiner, Bryan J; Zullig, Leah L; Lee, Shoou-Yih Daniel; Kravetz, Jeffrey D; Rakley, Susan M; Roumie, Christianne L; Bowen, Michael E; Del Monte, Pamela S; Oddone, Eugene Z; Jackson, George L

2013-09-08

Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.

Parent perspectives on attrition from tertiary care pediatric weight management programs.

PubMed

Hampl, Sarah; Demeule, Michelle; Eneli, Ihuoma; Frank, Maura; Hawkins, Mary Jane; Kirk, Shelley; Morris, Patricia; Sallinen, Bethany J; Santos, Melissa; Ward, Wendy L; Rhodes, Erinn

2013-06-01

To describe parent/caregiver reasons for attrition from tertiary care weight management clinics/programs. A telephone survey was administered to 147 parents from weight management clinics/programs in the National Association of Children's Hospitals and Related Institutions' (now Children's Hospital Association's) FOCUS on a Fitter Future II collaborative. Scheduling, barriers to recommendation implementation, and transportation issues were endorsed by more than half of parents as having a moderate to high influence on their decision not to return. Family motivation and mismatched expectations between families and clinic/program staff were mentioned as influential by more than one-third. Only mismatched expectations correlated with patient demographics and program characteristics. [corrected]. Although limited by small sample size, the study found that parents who left geographically diverse weight management clinics/programs reported similar reasons for attrition. Future efforts should include offering alternative visit times, more treatment options, and financial and transportation assistance and exploring family expectations.

CUDAEASY - a GPU accelerated cosmological lattice program

NASA Astrophysics Data System (ADS)

Sainio, J.

2010-05-01

This paper presents, to the author's knowledge, the first graphics processing unit (GPU) accelerated program that solves the evolution of interacting scalar fields in an expanding universe. We present the implementation in NVIDIA's Compute Unified Device Architecture (CUDA) and compare the performance to other similar programs in chaotic inflation models. We report speedups between one and two orders of magnitude depending on the used hardware and software while achieving small errors in single precision. Simulations that used to last roughly one day to compute can now be done in hours and this difference is expected to increase in the future. The program has been written in the spirit of LATTICEEASY and users of the aforementioned program should find it relatively easy to start using CUDAEASY in lattice simulations. The program is available at http://www.physics.utu.fi/theory/particlecosmology/cudaeasy/ under the GNU General Public License.

NASA's Radioisotope Power Systems Program Status

NASA Technical Reports Server (NTRS)

Dudzinski, Leonard A.; Hamley, John A.; McCallum, Peter W.; Sutliff, Thomas J.; Zakrajsek, June F.

2013-01-01

NASA's Radioisotope Power Systems (RPS) Program began formal implementation in December 2010. The RPS Program's goal is to make available RPS for the exploration of the solar system in environments where conventional solar or chemical power generation is impractical or impossible to meet mission needs. To meet this goal, the RPS Program manages investments in RPS system development and RPS technologies. The current keystone of the RPS Program is the development of the Advanced Stirling Radioisotope Generator (ASRG). This generator will be about four times more efficient than the more traditional thermoelectric generators, while providing a similar amount of power. This paper provides the status of the RPS Program and its related projects. Opportunities for RPS generator development and targeted research into RPS component performance enhancements, as well as constraints dealing with the supply of radioisotope fuel, are also discussed in the context of the next ten years of planetary science mission plans.

Programming scheme based optimization of hybrid 4T-2R OxRAM NVSRAM

NASA Astrophysics Data System (ADS)

Majumdar, Swatilekha; Kingra, Sandeep Kaur; Suri, Manan

2017-09-01

In this paper, we present a novel single-cycle programming scheme for 4T-2R NVSRAM, exploiting pulse engineered input signals. OxRAM devices based on 3 nm thick bi-layer active switching oxide and 90 nm CMOS technology node were used for all simulations. The cell design is implemented for real-time non-volatility rather than last-bit, or power-down non-volatility. Detailed analysis of the proposed single-cycle, parallel RRAM device programming scheme is presented in comparison to the two-cycle sequential RRAM programming used for similar 4T-2R NVSRAM bit-cells. The proposed single-cycle programming scheme coupled with the 4T-2R architecture leads to several benefits such as- possibility of unconventional transistor sizing, 50% lower latency, 20% improvement in SNM and ∼20× reduced energy requirements, when compared against two-cycle programming approach.

Reduction of Broad-Spectrum Antimicrobial Use in a Tertiary Children's Hospital Post Antimicrobial Stewardship Program Guideline Implementation.

PubMed

Lee, Kelley R; Bagga, Bindiya; Arnold, Sandra R

2016-03-01

The core strategies recommended for antimicrobial stewardship programs, formulary restriction with preauthorization and prospective audit and feedback, can be difficult to implement with limited resources; therefore, we took an approach of guideline development and education with the goal of reducing overall antibiotic use and unwarranted use of broad-spectrum antimicrobials. Retrospective chart review before and after intervention. Le Bonheur Children's Hospital pediatric, neonatal, and cardiac ICUs. All patients in our pediatric, neonatal, and cardiac ICUs within the time frame of the study. Baseline review in our ICUs revealed excessive use of broad-spectrum antibiotics and inconsistency in managing common pediatric infections. Guidelines were developed and implemented using cycles of education, retrospective review, and feedback. Purchasing and antibiotic use data were obtained to assess changes before and after guideline implementation. Unit-specific days of therapy were measured using periodic chart audit. Segmented regression analysis was used to assess changes in purchasing and broad-spectrum antibiotic days of therapy. The change in median monthly purchases was assessed using 2-tail Student t test. Hospital-wide targeted broad-spectrum antibiotic days of therapy/1,000 patient-days during the preimplementation year averaged 105 per month and decreased 33% to 70 per month during the postimplementation year. The overall antibiotic days of therapy decreased 41%, 21%, and 18%, and targeted broad-spectrum antibiotic days of therapy decreased by 99%, 75%, and 61% in the cardiac, pediatric, and neonatal ICUs, respectively, after guideline implementation. Yearly purchases of our most common broad-spectrum antibiotics decreased 62% from $230,059 to $86,887 after guideline implementation. Median monthly purchases of these drugs before implementation were $19,389 and $11,043 after implementation (p < 0.001). Guideline implementation was successful in reducing targeted broad-spectrum antibiotic use and acquisition cost. Programs with very limited resources may find similar implementation of guidelines effective to provide initial success, so that putting into practice one of the more resource intensive core strategies, such as prospective audit and feedback, may be feasible.

A pilot study of an online cognitive rehabilitation program for executive function skills in children with cancer-related brain injury

PubMed Central

Kesler, Shelli R.; Lacayo, Norman J.; Jo, Booil

2011-01-01

Primary objectives Children with a history of cancer are at increased risk for cognitive impairments, particularly in executive and memory domains. Traditional, in-person cognitive rehabilitation strategies may be unavailable and/or impractical for many of these children given difficulties related to resources and health status. The feasibility and efficacy of implementing a computerized, home-based cognitive rehabilitation curriculum designed to improve executive function skills was examined in these children. Methods A one-arm open trial pilot study of an original executive function cognitive rehabilitation curriculum was conducted with 23 paediatric cancer survivors aged 7–19. Results Compliance with the cognitive rehabilitation program was 83%, similar to that of many traditional programs. Following the cognitive intervention, participants showed significantly increased processing speed, cognitive flexibility, verbal and visual declarative memory scores as well as significantly increased pre-frontal cortex activation compared to baseline. Conclusions These results suggest that a program of computerized cognitive exercises can be successfully implemented at home in young children with cancer. These exercises may be effective for improving executive and memory skills in this group, with concurrent changes in neurobiologic status. PMID:21142826

High School Students’ Learning and Perceptions of Phylogenetics of Flowering Plants

PubMed Central

Landis, Jacob B.; Crippen, Kent J.

2014-01-01

Basic phylogenetics and associated “tree thinking” are often minimized or excluded in formal school curricula. Informal settings provide an opportunity to extend the K–12 school curriculum, introducing learners to new ideas, piquing interest in science, and fostering scientific literacy. Similarly, university researchers participating in science, technology, engineering, and mathematics (STEM) outreach activities increase awareness of college and career options and highlight interdisciplinary fields of science research and augment the science curriculum. To aid in this effort, we designed a 6-h module in which students utilized 12 flowering plant species to generate morphological and molecular phylogenies using biological techniques and bioinformatics tools. The phylogenetics module was implemented with 83 high school students during a weeklong university STEM immersion program and aimed to increase student understanding of phylogenetics and coevolution of plants and pollinators. Student response reflected positive engagement and learning gains as evidenced through content assessments, program evaluation surveys, and program artifacts. We present the results of the first year of implementation and discuss modifications for future use in our immersion programs as well as in multiple course settings at the high school and undergraduate levels. PMID:25452488

Price transparency for MRIs increased use of less costly providers and triggered provider competition.

PubMed

Wu, Sze-jung; Sylwestrzak, Gosia; Shah, Christiane; DeVries, Andrea

2014-08-01

To encourage patients to select high-value providers, an insurer-initiated price transparency program that focused on elective advanced imaging procedures was implemented. Patients having at least one outpatient magnetic resonance imaging (MRI) scan in 2010 or 2012 were divided according to their membership in commercial health plans participating in the program (the intervention group) or in nonparticipating commercial health plans (the reference group) in similar US geographic regions. Patients in the intervention group were informed of price differences among available MRI facilities and given the option of selecting different providers. For those patients, the program resulted in a $220 cost reduction (18.7 percent) per test and a decrease in use of hospital-based facilities from 53 percent in 2010 to 45 percent in 2012. Price variation between hospital and nonhospital facilities for the intervention group was reduced by 30 percent after implementation. Nonparticipating members residing in intervention areas also observed price reductions, which indicates increased price competition among providers. The program significantly reduced imaging costs. This suggests that patients select lower-price facilities when informed about available alternatives. Project HOPE—The People-to-People Health Foundation, Inc.

Factors associated with implementation of a multicomponent responsible beverage service program – results from two surveys in 290 Swedish municipalities

PubMed Central

2013-01-01

Background The purpose of this study was to investigate which factors affected the implementation of a multicomponent Responsible Beverage Service (RBS) program in 290 Swedish municipalities and whether the amount of such factors influenced the level of implementation of the program. Methods This study used variation in the presence of implementation-promoting factors to predict the level of implementation of the RBS program in municipalities throughout Sweden. The presence of such factors and the level of implementation of the program were studied by means of two surveys in all Swedish municipalities (N=290). Logistic regression and Spearman’s correlation analyses were used to analyze the relationship between implementation-promoting factors and the level of implementation of the RBS program. Results The response rates of the two surveys were 96% and 98%, respectively. One main finding was that program fidelity was low. Only 13% of the municipalities surveyed had implemented the RBS program as a whole, as stated in the specification of requirements. In municipalities reporting a higher amount of implementation-promoting factors, a significantly higher level of implementation of the program was shown. Evaluation and feedback was the only factor that correlated significantly with the level of implementation of the RBS program as a whole. Conclusion Evaluation and feedback constitutes an important implementation-promoting factor also in complex programs like the RBS program. Program fidelity is significant for the outcome of an intervention and must be a major focus of the implementation processes. PMID:23497692

Employee health surveillance in the health care industry.

PubMed

Hood, Joyce; Larrañaga, Michael

2007-10-01

This article provides an overview of the fundamental and inherent challenges in developing a health surveillance program for a health care facility. These challenges are similar to those facing individuals responsible for developing health surveillance programs for multiple industries because several "mini-industries" exist within hospitals. Hazards can range from those that are regulated by the Occupational Safety and Health Administration to those that are unregulated but pose a threat to health care workers. Occupational hazards that are unique to the health care industry also exist. A health surveillance program can be developed with focused assessment and a strong occupational safety and health program. Implementation can occur within a health care setting with the buy-in of the many stakeholders involved, especially supervisors managing departments where chemical and other hazards are present.

An institutional review board-based clinical research quality assurance program.

PubMed

Lad, Pramod M; Dahl, Rebecca

2013-01-01

Despite the acknowledged importance of quality assurance in the clinical research process, the problem of how such a program should be implemented at the level of an academic teaching hospital or a similar institution has not been addressed in the literature. Despite the fact that quality assurance is expected in programs which certify and accredit Institutional Review Boards (IRBs), very little is known about the role of the IRB in programs of clinical research quality assurance. In this article we consider the definition of clinical research quality assurance, and describe a program designed to achieve it. The key elements of such a program are education at the site level, which has both mandatory and voluntary components, and an auditing and monitoring program, which reinforces the education on quality assurance. The role of the IRB in achieving the program goals and the organizational placement of the quality assurance program within the IRB structure and function are important items of discussion.

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study

PubMed Central

P. van Dijk, Jitse

2017-01-01

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH. PMID:29236067

Description and evaluation of a hearing conservation program in use in a professional symphony orchestra.

PubMed

O'Brien, Ian; Driscoll, Tim; Ackermann, Bronwen

2015-04-01

Professional orchestral musicians risk permanent hearing loss while playing their instruments. Protecting the hearing of these musicians in the workplace is critical to their ongoing ability to play their instruments, but typical workplace hearing conservation measures can have very damaging effects on the product (music) and the musicians' abilities to hear one another sufficiently. To enable effective intervention, orchestras as employers must encourage engagement with hearing protection programs and implement controls while preserving the integrity of the music. To achieve this, typical approaches used in other industries must be redesigned to suit this unique workplace. In response to these challenges, the Queensland Symphony Orchestra (Brisbane, Australia) introduced a comprehensive hearing conservation strategy in 2005 based upon best practice at the time. This strategy-which has been regularly refined-continues to be implemented on a daily basis. This investigation aimed to assess the successes, difficulties, and practical viability of the program. To achieve this a process evaluation was carried out, incorporating archival analyses, player and management focus groups, and an interview with the program's administrator. Results show the program has successfully become integrated into the orchestra's and the musicians' daily operations and significantly contributes to managing the risk of hearing loss in this population. While there is room for improvement in the orchestra's approach-particularly regarding usable personal protective devices and improved education and training, results are encouraging. This study provides a basis for those wishing to implement or evaluate similar paradigms. © The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

The Safer Delivery of Surgical Services Program (S3): Explaining Its Differential Effectiveness and Exploring Implications for Improving Quality in Complex Systems.

PubMed

Flynn, Lorna C; McCulloch, Peter G; Morgan, Lauren J; Robertson, Eleanor R; New, Steve J; Stedman, Francesca E; Martin, Graham P

2016-12-01

To analyze the challenges encountered during surgical quality improvement interventions, and explain the relative success of different intervention strategies. Understanding why and how interventions work is vital for developing improvement science. The S3 Program of studies tested whether combining interventions addressing culture and system was more likely to result in improvement than either approach alone. Quantitative results supported this theory. This qualitative study investigates why this happened, what aspects of the interventions and their implementation most affected improvement, and the implications for similar programs. Semistructured interviews were conducted with hospital staff (23) and research team members (11) involved in S3 studies. Analysis was based on the constant comparative method, with coding conducted concurrently with data collection. Themes were identified and developed in relation to the program theory behind S3. The superior performance of combined intervention over single intervention arms appeared related to greater awareness and ability to act, supporting the S3 hypothesis. However, we also noted unforeseen differences in implementation that seemed to amplify this difference. The greater ambition and more sophisticated approach in combined intervention arms resulted in requests for more intensive expert support, which seemed crucial in their success. The contextual challenges encountered have potential implications for the replicability and sustainability of the approach. Our findings support the S3 hypothesis, triangulating with quantitative results and providing an explanatory account of the causal relationship between interventions and outcomes. They also highlight the importance of implementation strategies, and of factors outside the control of program designers.

Integrating evidence-based practices for increasing cancer screenings in safety net health systems: a multiple case study using the Consolidated Framework for Implementation Research.

PubMed

Liang, Shuting; Kegler, Michelle C; Cotter, Megan; Emily, Phillips; Beasley, Derrick; Hermstad, April; Morton, Rentonia; Martinez, Jeremy; Riehman, Kara

2016-08-02

Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover, our analytic approach is similar to previous case studies using CFIR and hence could facilitate comparisons across studies.

Strategic Plan. Volume 1

NASA Technical Reports Server (NTRS)

2002-01-01

The purpose of this document is to present the strategic plan and associated organizational structure that the National Space Biomedical Research Institute (NSBRI) will utilize to achieve the defined mission and objectives provided by NASA. Much of the information regarding the background and establishment of the NSBRI by NASA has been provided in other documentation and will not be repeated in this Strategic Plan. This Strategic Plan is presented in two volumes. Volume I (this volume) begins with an Introduction (Section 2) that provides the Institute's NASA-defined mission and objectives, and the organizational structure adopted to implement these through three Strategic Programs: Countermeasure Research; Education, Training and Outreach; and Cooperative Research and Development. These programs are described in Sections 3 to 5. Each program is presented in a similar way, using four subsections: Goals and Objectives; Current Strategies; Gaps and Modifications; and Resource Requirements. Section 6 provides the administrative infrastructure and total budget required to implement the Strategic Programs and assures that they form a single cohesive plan. This plan will ensure continued success of the Institute for the next five years. Volume II of the Strategic Plan provides an in-depth analysis of the current and future strategic programs of the 12 current NSBRI teams, including their goals, objectives, mutual interactions and schedules.

Results of the First Year of Active for Life: Translation of 2 Evidence-Based Physical Activity Programs for Older Adults Into Community Settings

PubMed Central

Wilcox, Sara; Dowda, Marsha; Griffin, Sarah F.; Rheaume, Carol; Ory, Marcia G.; Leviton, Laura; King, Abby C.; Dunn, Andrea; Buchner, David M.; Bazzarre, Terry; Estabrooks, Paul A.; Campbell-Voytal, Kimberly; Bartlett-Prescott, Jenny; Dowdy, Diane; Castro, Cynthia M.; Carpenter, Ruth Ann; Dzewaltowski, David A.; Mockenhaupt, Robin

2006-01-01

Objectives. Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults. Methods. Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys. Results. Participants (n=838) were aged an average of 68.4 ±9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index. Conclusions. The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials. PMID:16735619

Hough transform method for track finding in center drift chamber

NASA Astrophysics Data System (ADS)

Azmi, K. A. Mohammad Kamal; Wan Abdullah, W. A. T.; Ibrahim, Zainol Abidin

2016-01-01

Hough transform is a global tracking method used which had been expected to be faster approach for tracking the circular pattern of electron moving in Center Drift Chamber (CDC), by transforming the point of hit into a circular curve. This paper present the implementation of hough transform method for the reconstruction of tracks in Center Drift Chamber (CDC) which have been generated by random number in C language programming. Result from implementation of this method shows higher peak of circle parameter value (xc,yc,rc) that indicate the similarity value of the parameter needed for circular track in CDC for charged particles in the region of CDC.

Problems in characterizing barrier performance

NASA Technical Reports Server (NTRS)

Jordan, Harry F.

1988-01-01

The barrier is a synchronization construct which is useful in separating a parallel program into parallel sections which are executed in sequence. The completion of a barrier requires cooperation among all executing processes. This requirement not only introduces the wait for the slowest process delay which is inherent in the definition of the synchronization, but also has implications for the efficient implementation and measurement of barrier performance in different systems. Types of barrier implementation and their relationship to different multiprocessor environments are described. Then the problem of measuring the performance of barrier implementations on specific machine architecture is discussed. The fact that the barrier synchronization requires the cooperation of all processes makes the problem of performance measurement similarly global. Making non-intrusive measurements of sufficient accuracy can be tricky on systems offering only rudimentary measurement tools.

Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain.

PubMed

Chao, Maria T; Abercrombie, Priscilla D; Santana, Trilce; Duncan, Larissa G

2015-12-01

The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures.

PubMed

de Lambert, Guénolée; Fourcade, Laurent; Centi, Joachim; Fredon, Fabien; Braik, Karim; Szwarc, Caroline; Longis, Bernard; Lardy, Hubert

2013-06-01

Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit. We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department's internal organization, the organization within the hospital complex, and cost were evaluated. A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7-18 years) and average weight of 26 kg (range, 6-77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70-550 min), and average hospital stay was 6.4 days (range, 2-24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5-43 months). Robotic surgical procedure had an extra cost of 1934 compared to conventional open surgery. Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.

The impact of prison reentry services on short-term outcomes: evidence from a multisite evaluation.

PubMed

Lattimore, Pamela K; Visher, Christy A

2013-01-01

Renewed interest in prisoner rehabilitation to improve postrelease outcomes occurred in the 1990s, as policy makers reacted to burgeoning prison populations with calls to facilitate community reintegration and reduce recidivism. In 2003, the Federal government funded grants to implement locally designed reentry programs. Adult programs in 12 states were studied to determine the effects of the reentry programs on multiple outcomes. A two-stage matching procedure was used to examine the effectiveness of 12 reentry programs for adult males. In the first stage, "intact group matching" was used to identify comparison populations that were similar to program participants. In the second stage, propensity score matching was used to adjust for remaining differences between groups. Propensity score weighted logistic regression was used to examine the impact of reentry program participation on multiple outcomes measured 3 months after release. The study population was 1,697 adult males released from prisons in 2004-2005. Data consisted of interview data gathered 30 days prior to release and approximately 3 months following release, supplemented by administrative data from state departments of correction and the National Crime Information Center. Results suggest programs increased in-prison service receipt and produced modest positive outcomes across multiple domains (employment, housing, and substance use) 3 months after release. Although program participants reported fewer crimes, differences in postrelease arrest and reincarceration were not statistically significant. Incomplete implementation and service receipt by comparison group members may have resulted in insufficient statistical power to identify stronger treatment effects.

Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

PubMed

Whellan, David J; Cohen, Elizabeth J; Matchar, David B; Califf, Robert M

2002-07-01

Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations. To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM. Qualitative survey. Forty-seven healthcare systems (n = 22) and managed care organizations (n = 25) were randomly selected. Decision makers were identified and interviewed between January 1, 2000, and March 31, 2000. We limited quantitative analysis to tabulations of suitable responses, without statistical testing. Responses were organized around 3 themes: models for DM, implementation strategies, and measurements of success. Of 47 decision makers surveyed, 42 (89%) reported that their organizations currently have (75%) or are working to develop (14%) DM programs. Although the goals of DM programs were similar, organizations took a variety of approaches to achieving these ends. There were typically 3 steps in implementing a DM program: analysis of patient data, external analysis, and organizational analysis. Decision makers believed that DM programs had only achieved partial success in reaching the 2 main goals of improved quality of care and cost savings. Given the variety of DM programs, there is a need to develop a classification scheme to allow for better comparison between programs. Further quantitative studies of decision makers' opinions would be helpful in developing programs and in designing necessary studies of patient management strategies.

Cost-Effectiveness of a Family Planning Voucher Program in Rural Pakistan.

PubMed

Broughton, Edward Ivor; Hameed, Waqas; Gul, Xaher; Sarfraz, Shabnum; Baig, Imam Yar; Villanueva, Monica

2017-01-01

This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.

Medicare Program Associated With Narrowing Hospital Readmission Disparities Between Black And White Patients.

PubMed

Figueroa, José F; Zheng, Jie; Orav, E John; Epstein, Arnold M; Jha, Ashish K

2018-04-01

The Hospital Readmissions Reduction Program has been associated with improvements in readmission rates, yet little is known about its effect on racial disparities. We compared trends in thirty-day readmission rates for congestive heart failure, acute myocardial infarction, and pneumonia among non-Hispanic whites versus non-Hispanic blacks, and among minority-serving hospitals versus others. During the penalty-free implementation period (April 2010-September 2012), readmission rates improved over pre-implementation trends (January 2007-March 2010) for both whites and blacks, with a significantly greater decline among blacks than among whites (-0.45 percent versus -0.36 percent per quarter, respectively). In the period October 2012-December 2014, after penalties began, readmission improvements slowed for both races. Following a similar pattern, minority-serving hospitals saw greater reductions in readmissions than other hospitals did. Despite the narrowing of the two race-based gaps after announcement of the Hospital Readmissions Reduction Program, both persist. It remains to be seen whether new policy efforts will narrow these gaps and reduce the disproportionately high penalties that minority-serving hospitals face.

Diabetes mellitus disease management in a safety net hospital system: translating evidence into practice.

PubMed

Butler, Michael K; Kaiser, Michael; Johnson, Jolene; Besse, Jay; Horswell, Ronald

2010-12-01

The Louisiana State University Health Care Services Division system assessed the effectiveness of implementing a multisite disease management program targeting diabetes mellitus in an indigent patient population. A population-based disease management program centered on evidence-based clinical care guidelines was applied from the system level. Specific clinic modifications and models were used, as well as ancillary services such as medication assistance and equipment subsidies. Marked improvement in process goals led to improved clinical outcomes. From 2001 to 2008, the percentage of patients with a hemoglobin A1c < 7.0 increased from 45% to 55% on the system level, with some sites experiencing a more dramatic shift. Results were similar across sites, which included both small provider groups and academic health centers. In order to achieve these results, the clinical environment changed to promote those evidence-based interventions. Even in complex environments such as academic health centers with several provider levels, or those environments with limited care resources, disease management programs can be successfully implemented and achieve statistically significant results.

A Multistate Asian-Language Tobacco Quitline: Addressing a Disparity in Access to Care.

PubMed

Cummins, Sharon E; Wong, Shiushing; Bonnevie, Erika; Lee, Hye-Ryeon; Goto, Cynthia J; McCree Carrington, Judy; Kirby, Carrie; Zhu, Shu-Hong

2015-10-01

We conducted a dissemination and implementation study to translate an intervention protocol for Asian-language smokers from an efficacy trial into an effective and sustainable multistate service. Three state tobacco programs (in California, Colorado, and Hawaii) promoted a multistate cessation quitline to 3 Asian-language-speaking communities: Chinese, Korean, and Vietnamese. The California quitline provided counseling centrally to facilitate implementation. Three more states joined the program during the study period (January 2010-July 2012). We assessed the provision of counseling, quitting outcomes, and dissemination of the program. A total of 2004 smokers called for the service, with 88.3% opting for counseling. Among those opting for counseling, the 6-month abstinence rate (18.8%) was similar to results of the earlier efficacy trial (16.4%). The intervention protocol, based on an efficacy trial, was successfully translated into a multistate service and further disseminated. This project paved the way for the establishment of a national quitline for Asian-language speakers, which serves as an important strategy to address disparities in access to care.

The need for anal dysplasia screening and treatment programs for HIV-infected men who have sex with men: a review of the literature.

PubMed

Roark, Randall

2011-01-01

Anal cancer rates, which were higher for men who have sex with men (MSM) compared to the general population before HIV, increased dramatically after the HIV epidemic began and continue to increase in HIV-infected MSM despite the advent of antiretroviral therapy and associated immune reconstitution. Because of the similarity to cervical cancer and an established link to human papillomavirus infection, many experts have called for widespread implementation of anal cytological screening and treatment programs, especially for HIV-infected MSM. However, other experts argue that it is too early for widespread implementation of such programs for reasons including lack of clear evidence that anal dysplasia is a precursor to anal cancer, or that detecting and treating anal dysplasia reduces the risk for developing anal cancer; lack of effective treatments for anal dysplasia when it is discovered; and lack of resources. This paper reviews current literature regarding these issues. Copyright © 2011 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Science Teachers' Response to the Digital Education Revolution

NASA Astrophysics Data System (ADS)

Nielsen, Wendy; Miller, K. Alex; Hoban, Garry

2015-08-01

We report a case study of two highly qualified science teachers as they implemented laptop computers in their Years 9 and 10 science classes at the beginning of the `Digital Education Revolution,' Australia's national one-to-one laptop program initiated in 2009. When a large-scale investment is made in a significant educational change, it is important to consider teachers perspectives and responses to such change and we draw from sociocultural perspectives for our analysis. Through interviews and classroom observations, our interpretive analysis identified four key tensions and contradictions. These include the following: (1) barriers to innovative science teaching; (2) maintaining classroom and school connectivity; (3) teacher versus student expectations; and (4) changes to classroom management. Analysis leads to implications for the future of this and similar programs. The study shows that while these two teachers were committed to developing and delivering technology-rich science lessons, there were many factors that challenge how the implementation progressed. The findings from this study have implications for the continued engagement of teachers in this and other jurisdictions considering the introduction of one-to-one laptop programs.

Launching online education for 911 telecommunicators and EMS personnel: experiences from the North Carolina Rapid Response to Stroke Project.

PubMed

Lellis, Julie C; Brice, Jane H; Evenson, Kelly R; Rosamond, Wayne D; Kingdon, David; Morris, Dexter L

2007-01-01

We describe the development and implementation of the North Carolina Rapid Response to Stroke (NCRRS) project--a community-based online education project developed for 911 telecommunicators and EMS personnel. Two online courses, one for 911 telecommunicators and one for EMS personnel, were designed to provide timely and accessible continuing education on stroke assessment and care. Eight county-based emergency management systems, representing 15 agencies, were recruited for participation in a 4-month trial of the online courses in 2003. A total of 150 telecommunicators and 208 EMS personnel completed the courses. Results showed high levels of participant satisfaction with the program and improvements in posttest scores; agency leaders also provided positive feedback on the project. Motivators to complete the education identified by participants included peers, agency support, and materials provided by the NCRRS project. Courses were revised on the basis of feedback and successfully sustained online through August 2006, providing free stroke education for almost 1,000 additional 911 telecommunicators and EMS personnel in North Carolina. We describe the process of development and implementation that ensured project success. The results of this study show the need for and value of online stroke education for emergency services personnel and describe the challenges of developing and implementing online continuing education for this population. Similar education programs should be developed. Programs should incorporate comprehensive recruitment programs and community-based networks that sustain interest and promote full participation in educational offerings.

Design and implementation of an inpatient disease management program.

PubMed

Cooper, G S; Armitage, K B; Ashar, B; Costantini, O; Creighton, F A; Raiz, P; Wong, R C; Carlson, M D

2000-07-01

To describe the development and implementation of an inpatient disease management program. Prospective observational study. On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines. For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients. An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

Successful Geriatric Rehabilitation: Effects on Patients' Outcome of a National Program to Improve Quality of Care, the SINGER Study.

PubMed

Holstege, Marije S; Caljouw, Monique A A; Zekveld, Ineke G; van Balen, Romke; de Groot, Aafke J; van Haastregt, Jolanda C M; Schols, Jos M G A; Hertogh, Cees M P M; Gussekloo, Jacobijn; Achterberg, Wilco P

2017-05-01

To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72-85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients' (care) needs, care coordination, team cooperation, and quality of care. Data on patients' characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00-2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01-2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09-3.63). This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Designing application software in wide area network settings

NASA Technical Reports Server (NTRS)

Makpangou, Mesaac; Birman, Ken

1990-01-01

Progress in methodologies for developing robust local area network software has not been matched by similar results for wide area settings. The design of application software spanning multiple local area environments is examined. For important classes of applications, simple design techniques are presented that yield fault tolerant wide area programs. An implementation of these techniques as a set of tools for use within the ISIS system is described.

Wind for Schools: Developing Education Programs to Train the Next Generation of the Wind Energy Workforce

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baring-Gould, I.; Flowers, L.; Kelly, M.

2009-08-01

This paper provides an overview of the Wind for Schools project elements, including a description of host and collegiate school curricula developed for wind energy and the status of the current projects. The paper also provides focused information on how schools, regions, or countries can become involved or implement similar projects to expand the social acceptance and understanding of wind energy.

Effects of Neuropeptide Y on Resilience to PTSD

DTIC Science & Technology

2011-04-01

combat operations. What can we learn from 9/11 that applies to our military forces? In 2008, the Army implemented a program under Brigadier General...and learn from stressful situations so they can deal with similar situations more efficiently in the future. Resilient people may often appear...emotions. Instead, they are better able to learn new skills from life experiences which enable them to be better able to handle future stresses

Talk the Talk: Implementing a Communication Curriculum for Surgical Residents.

PubMed

Newcomb, Anna B; Trickey, Amber W; Porrey, Melissa; Wright, Jeffrey; Piscitani, Franco; Graling, Paula; Dort, Jonathan

The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program. The curriculum is presented in quarterly modules over a 2-year cycle. Using our surgical simulation center for the training, we focused on proven strategies for interacting with patients and other providers. We trained and used former patients as standardized participants (SPs) in communication scenarios. Surgical simulation center in a 900-bed tertiary care hospital. Program learners were general surgery residents (postgraduate year 1-5). Trauma Survivors Network volunteers served as SPs in simulation scenarios. We identified several important lessons: (1) designing and implementing a new curriculum is a challenging process with multiple barriers and complexities; (2) several readily available facilitators can ease the implementation process; (3) with the right approach, learners, faculty, and colleagues are enthusiastic and engaged participants; (4) learners increasingly agree that communication skills can be improved with practice and appreciate the curriculum value; (5) patient SPs can be valuable members of the team; and importantly (6) the culture of patient-physician communication appears to shift with the implementation of such a curriculum. Our approach using Trauma Survivors Network volunteers as SPs could be reproduced in other institutions with similar programs. Faculty enthusiasm and support is strong, and learner participation is active. Continued focus on patient and family communication skills would enhance patient care for institutions providing such education as well as for institutions where residents continue on in fellowships or begin their surgical practice. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Implementation and clinical application of a deformation method for fast simulation of biological tissue formed by fibers and fluid.

PubMed

Sardinha, Ana Gabriella de Oliveira; Oyama, Ceres Nunes de Resende; de Mendonça Maroja, Armando; Costa, Ivan F

2016-01-01

The aim of this paper is to provide a general discussion, algorithm, and actual working programs of the deformation method for fast simulation of biological tissue formed by fibers and fluid. In order to demonstrate the benefit of the clinical applications software, we successfully used our computational program to deform a 3D breast image acquired from patients, using a 3D scanner, in a real hospital environment. The method implements a quasi-static solution for elastic global deformations of objects. Each pair of vertices of the surface is connected and defines an elastic fiber. The set of all the elastic fibers defines a mesh of smaller size than the volumetric meshes, allowing for simulation of complex objects with less computational effort. The behavior similar to the stress tensor is obtained by the volume conservation equation that mixes the 3D coordinates. Step by step, we show the computational implementation of this approach. As an example, a 2D rectangle formed by only 4 vertices is solved and, for this simple geometry, all intermediate results are shown. On the other hand, actual implementations of these ideas in the form of working computer routines are provided for general 3D objects, including a clinical application.

Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS): A Novel Application of Translational Research Methods

PubMed Central

Acosta, Joie; Ebener, Patricia; Driver, Jennifer; Keith, Jamie; Peebles, Dana

2013-01-01

Abstract Translational research is expanding, in part, because Evidence‐Based Programs or Practices (EBPs) are not adopted in many medical domains. However, little translational research exists on EBPs that are prevention programs delivered in nonclinical, community‐based settings. These organizations often have low capacity, which undermines implementation quality and outcomes. Rigorous translational research is needed in these settings so within a single study, capacity, implementation quality, and outcomes are measured and links between them tested. This paper overviews the study Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS), which tests how well a community‐based setting (Boys & Girls Clubs) conducts an EBP called Making Proud Choices that aims to prevent teen pregnancy and sexually transmitted infections, with and without an implementation support intervention called Getting To Outcomes. The study design is novel as it assesses: Getting To Outcomes’ impact on capacity, implementation quality, and outcomes simultaneously and in both study conditions; will assess sustainability by measuring capacity and fidelity a year after the Getting To Outcomes support ends; and will operate on a large scale similar to many national initiatives. Many studies have not incorporated all these elements and thus EQUIPS could serve as a model for translational research in many domains. PMID:23751031

GPU Accelerated Chemical Similarity Calculation for Compound Library Comparison

PubMed Central

Ma, Chao; Wang, Lirong; Xie, Xiang-Qun

2012-01-01

Chemical similarity calculation plays an important role in compound library design, virtual screening, and “lead” optimization. In this manuscript, we present a novel GPU-accelerated algorithm for all-vs-all Tanimoto matrix calculation and nearest neighbor search. By taking advantage of multi-core GPU architecture and CUDA parallel programming technology, the algorithm is up to 39 times superior to the existing commercial software that runs on CPUs. Because of the utilization of intrinsic GPU instructions, this approach is nearly 10 times faster than existing GPU-accelerated sparse vector algorithm, when Unity fingerprints are used for Tanimoto calculation. The GPU program that implements this new method takes about 20 minutes to complete the calculation of Tanimoto coefficients between 32M PubChem compounds and 10K Active Probes compounds, i.e., 324G Tanimoto coefficients, on a 128-CUDA-core GPU. PMID:21692447

One year follow-up of the Chicago televised smoking cessation program.

PubMed Central

Flay, B R; Gruder, C L; Warnecke, R B; Jason, L A; Peterson, P

1989-01-01

We compared the relative effectiveness of four different conditions of self-help and social support provided to people attempting to quit smoking in conjunction with a televised cessation program: Smokers ready to quit were able to request written manuals from hardware stores to accompany a televised program. At worksites we provided the written manual to all workers. At a random half of the worksites, we also provided training to discussion leaders who subsequently led discussions among smokers attempting to quit with the program. At health maintenance organization sites we invited smokers who had requested program materials to participate in similar group discussions at health centers. In this paper we report one year follow-up results for the above four groups and compare them with previously reported results of a self-help manual alone. Results for the television plus manual condition were better than those of past studies (25 percent nonsmoking prevalence and 10 percent continuous cessation one year after the program) and considerably better than the manual alone. None of the other conditions designed to supplement the manual plus television produced better long-term outcomes; we explore the reasons for this. The program did encourage and help over 50,000 Chicago smokers to attempt quitting with the American Lung Association manual, 100 times as many as would have done so without the televised program. At least 15 other similar programs implemented since 1984 multiply this effect. PMID:2782506

Enhanced Recovery After Surgery: A Review.

PubMed

Ljungqvist, Olle; Scott, Michael; Fearon, Kenneth C

2017-03-01

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.

"During early implementation you just muddle through": factors that impacted a statewide arthritis program's implementation.

PubMed

Conte, Kathleen P; Marie Harvey, S; Turner Goins, R

2017-12-01

The need to scale-up effective arthritis self-management programs is pressing as the prevalence of arthritis increases. The CDC Arthritis Program funds state health departments to work with local delivery systems to embed arthritis programs into their day-to-day work. To encourage organizational ownership and sustainability of programs, funding is restricted to offset program start-up costs. The purpose of this study was to identify factors that impacted the success of implementing an evidence-based arthritis self-management program, funded by the CDC Arthritis Program, into the Oregon Extension Service. We interviewed staff and partners involved in implementation who had and had not successfully delivered Walk With Ease (N = 12) to identify barriers and facilitators to scaling-up. Document analysis of administrative records was used to triangulate and expand on findings. Delivery goals defined by the funder were not met in Year 1: only 3 of the expected 28 programs were delivered. Barriers to implementation included insufficient planning for implementation driven by pressure to deliver programs and insufficient resources to support staff time. Facilitators included centralized administration of key implementation activities and staffs' previous experience implementing new programs. The importance of planning and preparing for implementation cannot be overlooked. Funders, however, eager to see deliverables, continue to define implementation goals in terms of program reach, exclusive of capacity-building. Lack of capacity-building can jeopardize staff buy-in, implementation quality, and sustainability. Based on our findings coupled with support from implementation literature, we offer recommendations for future large-scale implementation efforts operating under such funding restrictions.

Showcasing the InTeGrate STEP Center principles and implementation programs through interactive webinars and websites

NASA Astrophysics Data System (ADS)

Orr, C. H.; McFadden, R.; Manduca, C. A.; Newman, A.

2016-12-01

Teaching sustainability curriculum provides an opportunity for building connections between academic learning and examples, experiences, and issues from beyond academia. Done well, this can increase students interest in a topic that feels relevant to their lives and help them transfer this learning to real life situations in their professional and personal lives. To support this approach to teaching, the NSF STEP Center InTeGrate developed a set of five core principles to guide development of teaching materials and programs that draw content from grand challenges to society and work to improve students' ability to understand the nature of science and think like a scientist. These principles include both effective pedagogical approaches and an interdisciplinary framework and are reflected in example curriculum modules, and implementation programs supported by InTeGrate. In order to promote adoption of teaching aligned with the InTeGrate philosophy and to use the InTeGrate-developed materials as tools, we organized a public webinar series led by materials developers and program leaders in the InTeGrate community. The webinars highlight programs that have addressed bigger-scale challenges such as increasing diversity of our majors and creating pathways to the workforce, as well as the materials used by these programs. They provide detailed examples designed to help other groups implement similar programs including showcase teaching activities and examples of their use in a wide range of settings. The webinars are interactive, with built-in activities and reflections that promote discussion among participants and speakers. Topics include natural hazards and risks, water resources and sustainability, energy and atmosphere, integrating sustainability into your course, and tracing environmental contaminants. These have clear components of geoscience, but promote an interdisciplinary perspective, that provides a deeper and more thorough discussion. Each webinar is archived on the InTeGrate website. We invite people to learn about InTeGrate teaching strategies, activities, and interdisciplinary approaches, and models for implementing the principles highlighted through the STEP Center work.

Apollo experience report: Guidance and control systems. Engineering simulation program

NASA Technical Reports Server (NTRS)

Gilbert, D. W.

1973-01-01

The Apollo Program experience from early 1962 to July 1969 with respect to the engineering-simulation support and the problems encountered is summarized in this report. Engineering simulation in support of the Apollo guidance and control system is discussed in terms of design analysis and verification, certification of hardware in closed-loop operation, verification of hardware/software compatibility, and verification of both software and procedures for each mission. The magnitude, time, and cost of the engineering simulations are described with respect to hardware availability, NASA and contractor facilities (for verification of the command module, the lunar module, and the primary guidance, navigation, and control system), and scheduling and planning considerations. Recommendations are made regarding implementation of similar, large-scale simulations for future programs.

77 FR 70752 - Notice of Decision Regarding Requests for a Waiver of the Renewable Fuel Standard

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-27

...The Governors of several States requested that EPA waive the national volume requirements for the renewable fuel standard program (RFS or RFS program), pursuant to section 211(o)(7) of the Clean Air Act (the Act), based on the effects of the drought on feedstocks used to produce renewable fuel in 2012-2013. Several other parties submitted similar requests. Based on a thorough review of the record in this case, EPA finds that the evidence and information does not support a determination that implementation of the RFS program during the 2012- 2013 time period would severely harm the economy of a State, a region, or the United States. EPA is therefore denying the requests for a waiver.

Optimizing Interactive Development of Data-Intensive Applications

PubMed Central

Interlandi, Matteo; Tetali, Sai Deep; Gulzar, Muhammad Ali; Noor, Joseph; Condie, Tyson; Kim, Miryung; Millstein, Todd

2017-01-01

Modern Data-Intensive Scalable Computing (DISC) systems are designed to process data through batch jobs that execute programs (e.g., queries) compiled from a high-level language. These programs are often developed interactively by posing ad-hoc queries over the base data until a desired result is generated. We observe that there can be significant overlap in the structure of these queries used to derive the final program. Yet, each successive execution of a slightly modified query is performed anew, which can significantly increase the development cycle. Vega is an Apache Spark framework that we have implemented for optimizing a series of similar Spark programs, likely originating from a development or exploratory data analysis session. Spark developers (e.g., data scientists) can leverage Vega to significantly reduce the amount of time it takes to re-execute a modified Spark program, reducing the overall time to market for their Big Data applications. PMID:28405637

Promoting aging well: evaluation of Vital-Aging-Multimedia Program in Madrid, Spain.

PubMed

Caprara, Mariagiovanna; Fernández-Ballesteros, Rocío; Alessandri, Guido

2016-09-01

This article attests to the effectiveness of Vital Aging-Multimedia (VA-M, 'Vivir con Vitalidad-M'), a psycho-educational multimedia program designed to promote successful aging. The program was implemented over 3 months through 35 h of video lessons grouped into 15 thematic units addressing four domains of experience commonly associated with aging well: health and healthy habits, cognitive functioning, aging self-efficacy and well-being and social participation. In accordance with a quasi-experimental design, a total of 115 senior citizens (aged 54-82) participated: 73 subjects attended the VA-M, while 42 subjects with similar characteristics served as controls. All subjects were assessed before and after the program on target variables related to the above domains of functioning. Significant changes in most of the examined variables documented the positive effects of the program. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Measuring the Implementation Fidelity of Student Affairs Programs: A Critical Component of the Outcomes Assessment Cycle

ERIC Educational Resources Information Center

Gerstner, Jerusha J.; Finney, Sara J.

2013-01-01

Implementation fidelity assessment provides a means of measuring the alignment between the planned program and the implemented program. Unfortunately, the implemented program can differ from the planned program, resulting in ambiguous inferences about the planned program's effectiveness (i.e., it is uncertain if poor results are due to an…

Sustainability of teacher implementation of school-based mental health programs.

PubMed

Han, Susan S; Weiss, Bahr

2005-12-01

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

Development and validation of an online interactive, multimedia wound care algorithms program.

PubMed

Beitz, Janice M; van Rijswijk, Lia

2012-01-01

To provide education based on evidence-based and validated wound care algorithms we designed and implemented an interactive, Web-based learning program for teaching wound care. A mixed methods quantitative pilot study design with qualitative components was used to test and ascertain the ease of use, validity, and reliability of the online program. A convenience sample of 56 RN wound experts (formally educated, certified in wound care, or both) participated. The interactive, online program consists of a user introduction, interactive assessment of 15 acute and chronic wound photos, user feedback about the percentage correct, partially correct, or incorrect algorithm and dressing choices and a user survey. After giving consent, participants accessed the online program, provided answers to the demographic survey, and completed the assessment module and photographic test, along with a posttest survey. The construct validity of the online interactive program was strong. Eighty-five percent (85%) of algorithm and 87% of dressing choices were fully correct even though some programming design issues were identified. Online study results were consistently better than previously conducted comparable paper-pencil study results. Using a 5-point Likert-type scale, participants rated the program's value and ease of use as 3.88 (valuable to very valuable) and 3.97 (easy to very easy), respectively. Similarly the research process was described qualitatively as "enjoyable" and "exciting." This digital program was well received indicating its "perceived benefits" for nonexpert users, which may help reduce barriers to implementing safe, evidence-based care. Ongoing research using larger sample sizes may help refine the program or algorithms while identifying clinician educational needs. Initial design imperfections and programming problems identified also underscored the importance of testing all paper and Web-based programs designed to educate health care professionals or guide patient care.

Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach

PubMed Central

Goudreau, Johanne; Hudon, Éveline; Lussier, Marie-Thérèse; Bareil, Céline; Duhamel, Fabie; Lévesque, Lise; Turcotte, Alain; Lalonde, Gilles

2014-01-01

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities. PMID:26770705

Effects of a play program on creative thinking of preschool children.

PubMed

Garaigordobil, Maite; Berrueco, Laura

2011-11-01

The purpose of this study was to evaluate the effects of a play program in the creative thinking of preschool children. The study used a repeated measures experimental pretest-posttest design with control groups. The sample included 86 participants aged 5 to 6 years (53 experimental and 33 control participants). Before and after administering the program, two evaluation instruments were applied: The Torrance Test of Creative Thinking (Torrance, 1990) and Behaviors and Traits of Creative Personality Scale (Garaigordobil & Berrueco, 2007). The program consisted of a weekly 75-minute play session throughout the school year. ANOVA results showed that the program significantly increased the verbal creativity (fluency, flexibility, originality), graphic creativity (elaboration, fluency, originality), and behaviors and traits of creative personality. In the pretest phase, there were no differences in the creativity of boys and girls, and the program stimulated a similar level of change in both sexes. The discussion focuses on the importance of implementing creative programs with preschool children.

The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

PubMed

Beich, Jeff; Scanlon, Dennis P; Ulbrecht, Jan; Ford, Eric W; Ibrahim, Ibrahim A

2006-02-01

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

Mentoring interdisciplinary research teams for the study of sex and gender differences in health and disease.

PubMed

Miller, Virginia M; Bahn, Rebecca S

2013-09-01

Initiatives to hasten the translation of basic science discoveries to clinical care have necessitated the development of new approaches to interdisciplinary collaboration and training of future investigators. This has been nowhere more important than in the study of sex differences with implications for extension into areas of gender medicine. Clearly, gaining better understanding of the role that sex and gender play in health and disease is essential to the implementation of truly individualized medicine. This case report will describe our experiences in developing the Mayo Clinic Building Interdisciplinary Research Programs in Women's Health (BIRCWH) program, an interdisciplinary research and training program in women's health and sex and gender differences. We identify both our successes and the barriers we have encountered in order that others who are developing similar programs might benefit from our experiences.

National health education programs to promote healthy eating and physical activity.

PubMed

Donato, Karen A

2006-02-01

The national education programs and campaigns described here are examples of the many unique kinds of federal efforts under way to promote the pillars of healthy eating and increased physical activity included in the "Healthier US Initiative." They are similar in that: 1) they are based on the best available science that a health problem exists, and 2) that healthy eating and physical active behaviors will improve health status. They are unique in their implementation, for example, in private/public partnerships, coordinating committees of professional associations, and congressionally mandated interventions. Most importantly, they provide the impetus to get a particular health issue on the public agenda.

Program Implementers' Evaluation of the Project P.A.T.H.S.: Findings Based on Different Datasets over Time

PubMed Central

Shek, Daniel T. L.; Ma, Cecilia M. S.

2012-01-01

This paper integrates the evaluation findings based on program implementers in nine datasets collected from 2005 to 2009 (244 schools and 7,926 implementers). Using consolidated data with schools as the unit of analysis, results showed that program implementers generally had positive perceptions of the program, themselves, and benefits of the program, with more than four-fifths of the implementers regarding the program as beneficial to the program participants. The subjective outcome evaluation instrument was found to be internally consistent. Multiple regression analyses revealed that perceived qualities of the program and program implementers predicted perceived effectiveness of the program. In conjunction with evaluation findings based on other sources, the present study provides support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in Hong Kong. PMID:22629224

An NAFP Project: Use of Object Oriented Methodologies and Design Patterns to Refactor Software Design

NASA Technical Reports Server (NTRS)

Shaykhian, Gholam Ali; Baggs, Rhoda

2007-01-01

In the early problem-solution era of software programming, functional decompositions were mainly used to design and implement software solutions. In functional decompositions, functions and data are introduced as two separate entities during the design phase, and are followed as such in the implementation phase. Functional decompositions make use of refactoring through optimizing the algorithms, grouping similar functionalities into common reusable functions, and using abstract representations of data where possible; all these are done during the implementation phase. This paper advocates the usage of object-oriented methodologies and design patterns as the centerpieces of refactoring software solutions. Refactoring software is a method of changing software design while explicitly preserving its external functionalities. The combined usage of object-oriented methodologies and design patterns to refactor should also benefit the overall software life cycle cost with improved software.

Service to the Nation, Strength for the Future. Fiscal Year 2013 United States Army Annual Financial Report

DTIC Science & Technology

2013-01-01

implementing several internal monthly controls testing initiatives, and other similar accomplishments geared to achieving a full audit-ready financial report...existence and completeness of assets, internal controls, and other critical functions required to meet audit readiness goals. The Army is on-track...ensure the integrity of their reporting systems, programs, and operations. This section focuses on the Army’s system of internal controls to

Laminated Object Manufacturing-Based Design Ceramic Matrix Composites

DTIC Science & Technology

2001-04-01

components for DoD applications. Program goals included the development of (1) a new LOM based design methodology for CMC, (2) optimized preceramic polymer ...3.1.1-20 3.1.1-12 Detail of LOM Composites Forming System w/ glass fiber/ polymer laminate................ 3.1.1-21 3.1.1-13...such as polymer matrix composites have faced similar barriers to implementation. These barriers have been overcome through the development of suitable

A phenomenological approach to assessing a DUI/DWI program.

PubMed

Narag, Raymund E; Maxwell, Sheila Royo; Lee, Byung

2013-02-01

In an effort to find a more proactive solution to the problem of drunk driving, a midwestern city has implemented a Driving Under the Influence or Driving While Impaired (DUI/DWI) Court program, a derivative of the popular drug courts. Eligible participants are those who have had two or more drunk-driving offenses but who have not been convicted of a violent offense. Participants volunteer for a 36-week program in exchange for a suspension of their prison sentence. Program elements include drug/alcohol monitoring, support groups, counseling, and extensive supervision. Using a phenomenological approach, this article describes the challenges faced by 20 participants, how they navigated the program requirements, their key realizations about their conditions, and their views on the viability and effectiveness of the program. The article uses qualitative interviews of participants and stakeholders collected for a process evaluation of the DUI program, and official records collected for programming purposes. Findings from this research can be used broadly for programming purposes and can be used by other court jurisdictions that are developing similar programs.

Effects of using nursing home residents to serve as group activity leaders: lessons learned from the RAP project.

PubMed

Skrajner, Michael J; Haberman, Jessica L; Camp, Cameron J; Tusick, Melanie; Frentiu, Cristina; Gorzelle, Gregg

2014-03-01

Previous research has demonstrated that persons with early to moderate stage dementia are capable of leading small group activities for persons with more advanced dementia. In this study, we built upon this previous work by training residents in long-term care facilities to fill the role of group activity leaders using a Resident-Assisted Programming (RAP) training regimen. There were two stages to the program. In the first stage, RAP training was provided by researchers. In the second stage, RAP training was provided to residents by activities staff members of long-term care facilities who had been trained by researchers. We examine the effects of RAP implemented by researchers and by activities staff member on long-term care resident with dementia who took part in these RAP activities. We also examined effects produced by two types of small group activities: two Montessori-based activities and an activity which focuses on persons with more advanced dementia, based on the work of Jitka Zgola. Results demonstrate that levels of positive engagement seen in players during RAP (resident-led activities) were typically higher than those observed during standard activities programming led by site staff. In general, Montessori-Based Dementia Programming® produced more constructive engagement than Zgola-based programming (ZBP), though ZBP did increase a positive form of engagement involving observing activities with interest. In addition, RAP implemented by activities staff members produced effects that were, on the whole, similar to those produced when RAP was implemented by researchers. Implications of these findings for providing meaningful social roles for persons with dementia residing in long-term care, and suggestions for further research in this area, are discussed.

Implementation and evolution of a regional chronic disease self-management program.

PubMed

Liddy, Clare; Johnston, Sharon; Nash, Kate; Irving, Hannah; Davidson, Rachel

2016-08-15

To establish a comprehensive, community-based program to improve and sustain self-management support for individuals with chronic diseases and complement office-based strategies to support behaviour change. Health service delivery organizations. The Champlain Local Health Integration Network (LHIN), a health district in Eastern Ontario. We created Living Healthy Champlain (LHC), a regional organization providing peer leader training and coordination for the group Stanford Chronic Disease Self-Management Program (CDSMP); skills training and mentorship in behaviour change approaches for health care providers; and support to organizations to integrate self-management support into routine practice. We used the RE-AIM framework to evaluate the overall program's impact by exploring its reach, effectiveness, adoption, implementation and maintenance. A total of 232 Stanford CDSMP sessions (63 during the pilot project and 169 post-pilot) have been held at 127 locations in 24 cities across the Champlain LHIN, reaching approximately 4,000 patients. The effectiveness of the service was established through ongoing evidence reviews, a focus group and a pre-post utilization study of the pilot. LHC trained over 300 peer volunteers to provide the Stanford CDSMP sessions, 98 of whom continue to activelyhost workshops. An additional 1,327 providers have been trained in other models of self-management support, such as Health Coaching and Motivational Interviewing. Over the study period, LHC grew from a small pilot project to a regional initiative with sustainable provincial funding and was adopted by the province as a model for similar service delivery across Ontario. A community-based self-management program working in partnership with primary care can be effectively and broadly implemented in support of patients living with chronic conditions.

Strengthening the HIV Care Continuum in the Dominican Republic: Application of a Triadic Implementation Framework to Meet the UNAIDS 90-90-90 Treatment Goal.

PubMed

Bowman, Alex S; Mehta, Mili; Lerebours Nadal, Leonel; Halpern, Mina; Nicholas, Stephen W; Amesty, Silvia

2017-10-01

Innovative empirical frameworks to evaluate progress in efforts addressing HIV treatment and prevention barriers in resource-limited areas are sorely needed to achieve the UNAIDS 90-90-90 goal (90% diagnosed, 90% on treatment, and 90% virally suppressed). A triadic implementation framework (TIF) is a comprehensive conceptual tool for (1) monitoring attrition, (2) evaluating operational programs, and (3) measuring the impact of specific implementation goals within the care continuum. TIF will assess the effects of enhanced programs on adherence and virologic suppression within the HIV care continuum at a regional clinic in the Dominican Republic (Clínica de Familia La Romana [CFLR]) and its program serving high-risk, migratory batey (sugarcane cultivation) communities. A retrospective cohort study completed during 2015 collected deidentified data from a CFLR chart review of adult HIV patients diagnosed in 2013. The results were quantitatively analyzed and compared to 2011 cohort data. In 2013, 310 patients were diagnosed HIV positive. The results demonstrated 73% enrolling in care, 28% adhering to care, and 16% achieving viral load suppression. Engagement increased across all steps of the care continuum compared to a 2011 cohort, culminating in a significant increase in undetectable viral load from 4% to 16% (p < 0.001). The batey program showed significant increases in patient enrollment compared to the 2011 cohort (p < 0.001). Meeting the UNAIDS 90-90-90 goal requires enhanced services in high-burden, resource-limited regions. CFLR employs TIF to assess progress and programmatic areas in need of strengthening. Data suggest enhanced CFLR services improve outcomes. Given improvements, maintenance and expansion of similar programs are warranted to achieve the 90-90-90 goal.

MPF: A portable message passing facility for shared memory multiprocessors

NASA Technical Reports Server (NTRS)

Malony, Allen D.; Reed, Daniel A.; Mcguire, Patrick J.

1987-01-01

The design, implementation, and performance evaluation of a message passing facility (MPF) for shared memory multiprocessors are presented. The MPF is based on a message passing model conceptually similar to conversations. Participants (parallel processors) can enter or leave a conversation at any time. The message passing primitives for this model are implemented as a portable library of C function calls. The MPF is currently operational on a Sequent Balance 21000, and several parallel applications were developed and tested. Several simple benchmark programs are presented to establish interprocess communication performance for common patterns of interprocess communication. Finally, performance figures are presented for two parallel applications, linear systems solution, and iterative solution of partial differential equations.

Hough transform method for track finding in center drift chamber

DOE Office of Scientific and Technical Information (OSTI.GOV)

Azmi, K. A. Mohammad Kamal, E-mail: khasmidatul@siswa.um.edu.my; Wan Abdullah, W. A. T., E-mail: wat@um.edu.my; Ibrahim, Zainol Abidin

Hough transform is a global tracking method used which had been expected to be faster approach for tracking the circular pattern of electron moving in Center Drift Chamber (CDC), by transforming the point of hit into a circular curve. This paper present the implementation of hough transform method for the reconstruction of tracks in Center Drift Chamber (CDC) which have been generated by random number in C language programming. Result from implementation of this method shows higher peak of circle parameter value (xc,yc,rc) that indicate the similarity value of the parameter needed for circular track in CDC for charged particlesmore » in the region of CDC.« less

A model of service and training: threat assessment on a community college campus.

PubMed

Mrad, David F; Hanigan, Antoni J S; Bateman, Joyce R

2015-02-01

Forensic psychological assessment for targeted violence is a growing area of practice and community need. These threat assessments are particularly challenging on community college campuses given the broad range of students and the limited internal resources. A collaborative model of partnership between a community college and the training clinic of a doctoral program in clinical psychology has been developed and implemented. The model provides needed service to the community college and rich training experiences for doctoral students in psychology. Implementation of similar partnerships in other settings may be limited by the training and experience of doctoral faculty and the openness of behavioral intervention teams to external participants.

A model of therapist competencies for the empirically supported interpersonal psychotherapy for adolescent depression.

PubMed

Sburlati, Elizabeth S; Lyneham, Heidi J; Mufson, Laura H; Schniering, Carolyn A

2012-06-01

In order to treat adolescent depression, a number of empirically supported treatments (ESTs) have been developed from both the cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT-A) frameworks. Research has shown that in order for these treatments to be implemented in routine clinical practice (RCP), effective therapist training must be generated and provided. However, before such training can be developed, a good understanding of the therapist competencies needed to implement these ESTs is required. Sburlati et al. (Clin Child Fam Psychol Rev 14:89-109, 2011) developed a model of therapist competencies for implementing CBT using the well-established Delphi technique. Given that IPT-A differs considerably to CBT, the current study aims to develop a model of therapist competencies for the implementation of IPT-A using a similar procedure as that applied in Sburlati et al. (Clin Child Fam Psychol Rev 14:89-109, 2011). This method involved: (1) identifying and reviewing an empirically supported IPT-A approach, (2) extracting therapist competencies required for the implementation of IPT-A, (3) consulting with a panel of IPT-A experts to generate an overall model of therapist competencies, and (4) validating the overall model with the IPT-A manual author. The resultant model offers an empirically derived set of competencies necessary for effectively treating adolescent depression using IPT-A and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines. This model, therefore, provides an empirical framework for the development of dissemination and implementation programs aimed at ensuring that adolescents with depression receive effective care in RCP settings. Key similarities and differences between CBT and IPT-A, and the therapist competencies required for implementing these treatments, are also highlighted throughout this article.

Quantum metrology with a single spin-3/2 defect in silicon carbide

NASA Astrophysics Data System (ADS)

Soykal, Oney O.; Reinecke, Thomas L.

We show that implementations for quantum sensing with exceptional sensitivity and spatial resolution can be made using the novel features of semiconductor high half-spin multiplet defects with easy-to-implement optical detection protocols. To achieve this, we use the spin- 3 / 2 silicon monovacancy deep center in hexagonal silicon carbide based on our rigorous derivation of this defect's ground state and of its electronic and optical properties. For a single VSi- defect, we obtain magnetic field sensitivities capable of detecting individual nuclear magnetic moments. We also show that its zero-field splitting has an exceptional strain and temperature sensitivity within the technologically desirable near-infrared window of biological systems. Other point defects, i.e. 3d transition metal or rare-earth impurities in semiconductors, may also provide similar opportunities in quantum sensing due to their similar high spin (S >= 3 / 2) configurations. This work was supported in part by ONR and by the Office of Secretary of Defense, Quantum Science and Engineering Program.

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions.

PubMed

Stenehjem, Edward; Hyun, David Y; Septimus, Ed; Yu, Kalvin C; Meyer, Marc; Raj, Deepa; Srinivasan, Arjun

2017-08-15

Antibiotic stewardship programs (ASPs) improve antibiotic prescribing. Seventy-three percent of US hospitals have <200 beds. Small hospitals (<200 beds) have similar rates of antibiotic prescribing compared to large hospitals, but the majority of small hospitals lack ASPs that satisfy the Centers for Disease Control and Prevention's core elements. All hospitals, regardless of size, are now required to have ASPs by The Joint Commission, and the Centers for Medicare and Medicaid Services has proposed a similar requirement. Very few studies have described the successful implementation of ASPs in small hospitals. We describe barriers commonly encountered in small hospitals when constructing an antibiotic stewardship team, obtaining appropriate metrics of antibiotic prescribing, implementing antibiotic stewardship interventions, obtaining financial resources, and utilizing the microbiology laboratory. We propose potential solutions that tailor stewardship activities to the needs of the facility and the resources typically available. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Implementation of compressive sensing for preclinical cine-MRI

NASA Astrophysics Data System (ADS)

Tan, Elliot; Yang, Ming; Ma, Lixin; Zheng, Yahong Rosa

2014-03-01

This paper presents a practical implementation of Compressive Sensing (CS) for a preclinical MRI machine to acquire randomly undersampled k-space data in cardiac function imaging applications. First, random undersampling masks were generated based on Gaussian, Cauchy, wrapped Cauchy and von Mises probability distribution functions by the inverse transform method. The best masks for undersampling ratios of 0.3, 0.4 and 0.5 were chosen for animal experimentation, and were programmed into a Bruker Avance III BioSpec 7.0T MRI system through method programming in ParaVision. Three undersampled mouse heart datasets were obtained using a fast low angle shot (FLASH) sequence, along with a control undersampled phantom dataset. ECG and respiratory gating was used to obtain high quality images. After CS reconstructions were applied to all acquired data, resulting images were quantitatively analyzed using the performance metrics of reconstruction error and Structural Similarity Index (SSIM). The comparative analysis indicated that CS reconstructed images from MRI machine undersampled data were indeed comparable to CS reconstructed images from retrospective undersampled data, and that CS techniques are practical in a preclinical setting. The implementation achieved 2 to 4 times acceleration for image acquisition and satisfactory quality of image reconstruction.

How Do Implementation Efforts Relate to Program Adherence? Examining the Role of Organizational, Implementer, and Program Factors

ERIC Educational Resources Information Center

Dariotis, Jacinda K.; Bumbarger, Brian K.; Duncan, Larissa G.; Greenberg, Mark T.

2008-01-01

Widespread replications of evidence-based prevention programs (EBPPs) prompt prevention scientists to examine program implementation adherence in real world settings. Based on Chen's model (1990), we identified five key factors of the implementation system and assessed which characteristics related to program adherence. The sample included 32…

How does investment in research training affect the development of research networks and collaborations?

PubMed

Paina, Ligia; Ssengooba, Freddie; Waswa, Douglas; M'imunya, James M; Bennett, Sara

2013-05-20

Whether and how research training programs contribute to research network development is underexplored. The Fogarty International Center (FIC) has supported overseas research training programs for over two decades. FIC programs could provide an entry point in the development of research networks and collaborations. We examine whether FIC's investment in research training contributed to the development of networks and collaborations in two countries with longstanding FIC investments - Uganda and Kenya - and the factors which facilitated this process. As part of two case studies at Uganda's Makerere University and Kenya's University of Nairobi, we conducted 53 semi-structured in-depth interviews and nine focus group discussions. To expand on our case study findings, we conducted a focused bibliometric analysis on two purposively selected topic areas to examine scientific productivity and used online network illustration tools to examine the resulting network structures. FIC support made important contributions to network development. Respondents from both Uganda and Kenya confirmed that FIC programs consistently provided trainees with networking skills and exposure to research collaborations, primarily within the institutions implementing FIC programs. In both countries, networks struggled with inclusiveness, particularly in HIV/AIDS research. Ugandan respondents perceived their networks to be more cohesive than Kenyan respondents did. Network cohesiveness was positively correlated with the magnitude and longevity of FIC's programs. Support from FIC grants to local and regional research network development and networking opportunities, such as conferences, was rare. Synergies between FIC programs and research grants helped to solidify and maintain research collaborations. Networks developed where FIC's programs focused on a particular institution, there was a critical mass of trainees with similar interests, and investments for network development were available from early implementation. Networks were less likely to emerge where FIC efforts were thinly scattered across multiple institutions. The availability of complementary research grants created opportunities for researchers to collaborate in grant writing, research implementation, and publications. FIC experiences in Uganda and Kenya showcase the important role of research training programs in creating and sustaining research networks. FIC programs should consider including support to research networks more systematically in their capacity development agenda.

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-12-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-02-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

Defense Programs benchmarking in Chicago, April 1994: Identifying best practices in the pollution prevention programs of selected private industries

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-12-01

The Office of Defense Programs (DP) was the first US Department of Energy (DOE) Cognizant Secretarial Office (CSO) to attempt to benchmark private industries for best-in-class practices in the field of pollution prevention. Defense Programs` intent in this effort is to identify and bring to DOE field offices strategic and technological tools that have helped private companies minimize waste and prevent pollution. Defense Programs` premier benchmarking study focused on business practices and process improvements used to implement exceptional pollution prevention programs in four privately owned companies. The current interest in implementing partnerships information exchange, and technology transfer with the privatemore » sector prompted DP to continue to seek best practices in the area of pollution prevention through a second benchmarking endeavor in May 1994. This report presents the results of that effort. The decision was made to select host facilities that own processes similar to those at DOE plants and laboratories, that have programs that have been recognized on a local or national level, that have an interest in partnering with the Department on an information-sharing basis, and that are located in proximity to each other. The DP benchmarking team assessed the pollution prevention programs of five companies in the Chicago area--GE Plastics, Navistar, Northrop Corporation, Sundstrand and Caterpillar. At all facilities visited, Ozone Depleting Compounds (ODCs), hazardous wastes, releases under the Superfund Amendments and Reauthorization Act (SARA), waste water and non-hazardous wastes are being eliminated, replaced, reduced, recycled and reused whenever practicable.« less

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up.

PubMed

Skeffington, Petra M; Rees, Clare S; Mazzucchelli, Trevor G; Kane, Robert T

2016-01-01

To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The "control" group received "Training as Usual" (TAU). Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program. While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583.

The development, implementation, and assessment of an innovative faculty mentoring leadership program.

PubMed

Tsen, Lawrence C; Borus, Jonathan F; Nadelson, Carol C; Seely, Ellen W; Haas, Audrey; Fuhlbrigge, Anne L

2012-12-01

Effective mentoring is an important component of academic success. Few programs exist to both improve the effectiveness of established mentors and cultivate a multispecialty mentoring community. In 2008, in response to a faculty survey on mentoring, leaders at Brigham and Women's Hospital developed the Faculty Mentoring Leadership Program as a peer learning experience for midcareer and senior faculty physician and scientist mentors to enhance their skills and leadership in mentoring and create a supportive community of mentors. A planning group representing key administrative, educational, clinical, and research mentorship constituencies designed the nine-month course.Participants met monthly for an hour and a half during lunchtime. Two cofacilitators engaged the diverse group of 16 participants in interactive discussions about cases based on the participants' experiences. While the cofacilitators discussed with the participants the dyadic mentor-mentee relationship, they specifically emphasized the value of engaging multiple mentors and establishing mentoring networks. In response to postsession and postcourse (both immediately and after six months) self-assessments, participants reported substantive gains in their mentoring confidence and effectiveness, experienced a renewed sense of enthusiasm for mentoring, and took initial steps to build a diverse network of mentoring relationships.In this article, the authors describe the rationale, design, implementation, assessment, and ongoing impact of this innovative faculty mentoring leadership program. They also share lessons learned for other institutions that are contemplating developing a similar faculty mentoring program.

Case histories in pharmaceutical risk management.

PubMed

McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E

2009-12-01

The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

PubMed

Gelmon, Sherril; Bouranis, Nicole; Sandberg, Billie; Petchel, Shauna

2018-01-01

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care. © Copyright 2018 by the American Board of Family Medicine.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies?

PubMed

Campbell, Norm R C; Sheldon, Tobe

2010-07-01

To indicate the key elements of current Canadian programs to treat and control hypertension. In the early 1990s Canada had a hypertension treatment and control rate of 13%. A Canadian strategy to prevent and control hypertension was developed and a coalition of national organizations and volunteers formed to develop increasingly extensive programs. The Canadian effort was largely based on annually updated hypertension management recommendations, an integrated and extensive hypertension knowledge translation program and an increasingly comprehensive outcomes assessment program. After the start of the annual process in 1999, there were very large increases in diagnosis and hypertension treatment coupled with dropping rates of cardiovascular disease. More recent initiatives include an extensive education program for the public and people with hypertension, a program to reduce dietary salt and a funded leadership position. The treatment and control rate increased to 66% when last assessed (2007-2009). The study describes important aspects of the Canadian hypertension management programs to aid those wishing to develop similar programs. Many of the programs could be fully or partially implemented by other countries.

Design and Simulation of Material-Integrated Distributed Sensor Processing with a Code-Based Agent Platform and Mobile Multi-Agent Systems

PubMed Central

Bosse, Stefan

2015-01-01

Multi-agent systems (MAS) can be used for decentralized and self-organizing data processing in a distributed system, like a resource-constrained sensor network, enabling distributed information extraction, for example, based on pattern recognition and self-organization, by decomposing complex tasks in simpler cooperative agents. Reliable MAS-based data processing approaches can aid the material-integration of structural-monitoring applications, with agent processing platforms scaled to the microchip level. The agent behavior, based on a dynamic activity-transition graph (ATG) model, is implemented with program code storing the control and the data state of an agent, which is novel. The program code can be modified by the agent itself using code morphing techniques and is capable of migrating in the network between nodes. The program code is a self-contained unit (a container) and embeds the agent data, the initialization instructions and the ATG behavior implementation. The microchip agent processing platform used for the execution of the agent code is a standalone multi-core stack machine with a zero-operand instruction format, leading to a small-sized agent program code, low system complexity and high system performance. The agent processing is token-queue-based, similar to Petri-nets. The agent platform can be implemented in software, too, offering compatibility at the operational and code level, supporting agent processing in strong heterogeneous networks. In this work, the agent platform embedded in a large-scale distributed sensor network is simulated at the architectural level by using agent-based simulation techniques. PMID:25690550

Implementing practice guidelines: lessons from public mental health settings.

PubMed

Parks, Joseph J

2007-01-01

There is evidence that state-of-the-art psychiatric treatments are not being translated into community settings, resulting in the de facto denial of up-to-date psychiatric care for many Americans with mental illness. Although multiple models of evidence-based care exist, little is known about how to disseminate information regarding these models to clinicians in real-world practice. Suggested solutions have included the use of published practice guidelines, such as the American Psychiatric Association Practice Guidelines and the Expert Consensus Guidelines, or algorithm-based programs, such as the Texas Medication Algorithm Project. Unfortunately, the real-world utility of practice guidelines tends to be limited, because their implementation depends entirely on practitioner self-motivation. Similarly, the use of algorithm-based programs may be limited by their pervasive high specificity, practitioner resistance, and various patient misperceptions. Another solution is the implementation of evidence-based practices (EBPs), such as the Substance Abuse and Mental Health Services Administration (SAMHSA) EBPs. However, states' use of the SAMHSA EBPs has been hampered by misalignment of the funding structure, lack of information regarding EBPs, high costs to train and supervise staff, staff turnover, and a lack of resources. As a result, federal and clinical/professional agencies have called for a change in the nation's mental health care delivery system, supplying persuasive arguments for the economic and clinical superiority of integrated care models. One such model, the Missouri Medical Risk Management (MRM) Program for Medicaid Recipients with Schizophrenia, currently assists patients identified as being at high risk for adverse medical and behavioral outcomes. Preliminary results from the Missouri MRM Program are described.

Design and simulation of material-integrated distributed sensor processing with a code-based agent platform and mobile multi-agent systems.

PubMed

Bosse, Stefan

2015-02-16

Multi-agent systems (MAS) can be used for decentralized and self-organizing data processing in a distributed system, like a resource-constrained sensor network, enabling distributed information extraction, for example, based on pattern recognition and self-organization, by decomposing complex tasks in simpler cooperative agents. Reliable MAS-based data processing approaches can aid the material-integration of structural-monitoring applications, with agent processing platforms scaled to the microchip level. The agent behavior, based on a dynamic activity-transition graph (ATG) model, is implemented with program code storing the control and the data state of an agent, which is novel. The program code can be modified by the agent itself using code morphing techniques and is capable of migrating in the network between nodes. The program code is a self-contained unit (a container) and embeds the agent data, the initialization instructions and the ATG behavior implementation. The microchip agent processing platform used for the execution of the agent code is a standalone multi-core stack machine with a zero-operand instruction format, leading to a small-sized agent program code, low system complexity and high system performance. The agent processing is token-queue-based, similar to Petri-nets. The agent platform can be implemented in software, too, offering compatibility at the operational and code level, supporting agent processing in strong heterogeneous networks. In this work, the agent platform embedded in a large-scale distributed sensor network is simulated at the architectural level by using agent-based simulation techniques.

Food Safety Programs Based on HACCP Principles in School Nutrition Programs: Implementation Status and Factors Related to Implementation

ERIC Educational Resources Information Center

Stinson, Wendy Bounds; Carr, Deborah; Nettles, Mary Frances; Johnson, James T.

2011-01-01

Purpose/Objectives: The objectives of this study were to assess the extent to which school nutrition (SN) programs have implemented food safety programs based on Hazard Analysis and Critical Control Point (HACCP) principles, as well as factors, barriers, and practices related to implementation of these programs. Methods: An online survey was…

Peer education: a successful strategy with some constraints.

PubMed

Baldo, M

1998-01-01

The use of peer education programs to promote sexual health has been widely accepted because of the potential of such programs to be implemented in a cost-effective manner in various settings and because peers are considered more convincing than outsiders. In addition, the thousands of people who have received training to become peer educators constitute a new generation of social work and health professionals who are not embarrassed by sexuality. Problems encountered by peer health education programs include sustainability of volunteers and funding, difficulty in assessing the impact of a program (especially cost-effectiveness), and the lack of appropriate monitoring and evaluation indicators. Given the large turnover of peer educators and the resources needed to provide week-long residential training courses, new methods of training are needed that are less labor intensive and more cost effective. Another problem is that many facilitators of peer health education programs lack a background in health promotion, and sometimes peer education programs for similar audiences compete or send contradictory messages because of a lack of coordination.

Teaching Tradition: Diverse Perspectives on the Pilot Urban American Indian Traditional Spirituality Program.

PubMed

Gone, Joseph P; Blumstein, Katherine P; Dominic, David; Fox, Nickole; Jacobs, Joan; Lynn, Rebecca S; Martinez, Michelle; Tuomi, Ashley

2017-06-01

Many urban American Indian community members lack access to knowledgeable participation in indigenous spiritual practices. And yet, these sacred traditional activities remain vitally important to their reservation-based kin. In response, our research team partnered with an urban American Indian health center in Detroit for purposes of developing a structured program to facilitate more ready access to participation in indigenous spiritual knowledge and practices centered on the sweat lodge ceremony. Following years of preparation and consultation, we implemented a pilot version of the Urban American Indian Traditional Spirituality Program in the spring of 2016 for 10 urban AI community participants. Drawing on six first-person accounts about this program, we reflect on its success as a function of participant meaningfulness, staff support, mitigated sensitivities, and program structure. We believe that these observations will enable other community psychologists to undertake similar program development in service to innovative and beneficial impacts on behalf of their community partners. © Society for Community Research and Action 2017.

Implementing a Coach-Delivered Dating Violence Prevention Program with High School Athletes.

PubMed

Jaime, Maria Catrina D; McCauley, Heather L; Tancredi, Daniel J; Decker, Michele R; Silverman, Jay G; O'Connor, Brian; Miller, Elizabeth

2018-05-10

Teen dating violence and sexual violence are severe public health problems. Abusive behaviors within the context of dating or romantic relationships are associated with adverse health outcomes. Promoting positive bystander intervention and increasing knowledge of abusive behaviors are promising strategies for preventing dating and sexual violence. Coaching Boys Into Men (CBIM) is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes. Identifying specific barriers and facilitators based on the coaches' experiences with program delivery combined with the coaches' and athletes' program perceptions may help optimize future CBIM implementation and sustainability. Semi-structured interviews with coaches (n = 36) explored the implementers' perspectives on strategies that worked well and potential barriers to program implementation. Ten focus groups with male athletes (n = 39) assessed their experiences with CBIM and the suitability of having their coaches deliver this program. Coaches described using the CBIM training cards and integrating program delivery during practice. Athletes reported coaches routinely delivering the CBIM program and adding their own personal stories or examples to the discussions. Key facilitators to program implementation include support from the violence prevention advocate, the ease of integrating CBIM into the sports season, and using the program materials. Barriers to implementation included finding sufficient time for the program, dynamics of delivering sensitive program content, and participant constraints. Coaches and athletes alike found the program feasible and acceptable to implement within the sports setting. Both coaches and athletes offered insights on the implementation and the feasibility and acceptability of CBIM within school-based athletic programs. These experiences by implementers and recipients alike can inform future dissemination and implementation efforts of CBIM. Further, by pinpointing where and how coaches were successful in implementing the program and what resonated with athletes, can help better understand how CBIM is effective in promoting athletes to stop violence against women and girls. Coach and athlete reflections on CBIM implementation provide insights for optimizing future program delivery and dissemination.

The proactive approach--is it worthwhile? A prospective controlled ergonomic intervention study in office workers.

PubMed

Laestadius, Jasminka Goldoni; Ye, Jian; Cai, Xiaodong; Ross, Sandra; Dimberg, Lennart; Klekner, Meg

2009-10-01

Does proactive ergonomics program enhance office worker health and productivity? The investigation was conducted in connection with the move of 1500 office staff to a building with improved ergonomics. It was focused on associations between workstation features, working postures, musculoskeletal pain symptoms, and eye strain before and 18 months after implementation of a proactive ergonomic program. The outcomes were compared between the intervention and a similar reference group. Associations between improvement of postures and less musculoskeletal pain and eye strain were confirmed. A cross association between several features and postures and improved symptoms was noted, along with improved productivity. The study suggests that a proactive program adhering to the OSHA recommendations needs to include an individual workstation assessment to be effective in reducing symptoms and increasing productivity.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients

PubMed Central

Shelgikar, Anita Valanju; Aronovich, Sharon; Stanley, Jeffrey J.

2017-01-01

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary “Alternatives to CPAP program” (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients. Citation: Shelgikar AV, Aronovich S, Stanley JJ. Multidisciplinary alternatives to CPAP program for CPAP-intolerant patients. J Clin Sleep Med. 2017;13(3):505–510. PMID:28095977

Engaging pregnant and parenting teens: early challenges and lessons learned from the Evaluation of Adolescent Pregnancy Prevention Approaches.

PubMed

Asheer, Subuhi; Berger, Amanda; Meckstroth, Alicia; Kisker, Ellen; Keating, Betsy

2014-03-01

This article draws on data from the ongoing federal Evaluation of Adolescent Pregnancy Prevention Approaches to discuss the early implementation experiences of two new and innovative programs intended to delay rapid repeat pregnancy among teen mothers: (1) AIM 4 Teen Moms, in Los Angeles County, California; and (2) Teen Options to Prevent Pregnancy (T.O.P.P.), in Columbus, Ohio. Program staff report common challenges in working with teen mothers, particularly concerning recruitment and retention, staff capacity and training, barriers to participation, and participants' overarching service needs. Lessons learned in addressing these challenges provide useful guidance to program developers, providers, policy makers, and stakeholders working with similar populations. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Film/chemistry selection for the earth resources technology satellite /ERTS/ ground data handling system

NASA Technical Reports Server (NTRS)

Shaffer, R. M.

1973-01-01

A detailed description is given of the methods of choose the duplication film and chemistry currently used in the NASA-ERTS Ground Data Handling System. The major ERTS photographic duplication goals are given as background information to justify the specifications for the desirable film/chemistry combination. Once these specifications were defined, a quantitative evaluation program was designed and implemented to determine if any recommended combinations could meet the ERTS laboratory specifications. The specifications include tone reproduction, granularity, MTF and cosmetic effects. A complete description of the techniques used to measure the test response variables is given. It is anticipated that similar quantitative techniques could be used on other programs to determine the optimum film/chemistry consistent with the engineering goals of the program.

Innovative and Community-Guided Evaluation and Dissemination of a Prostate Cancer Education Program for African-American Men and Women

PubMed Central

Jackson, Dawnyea D.; Owens, Otis L.; Friedman, Daniela B.; Dubose-Morris, Ragan

2014-01-01

African Americans (AA) are more likely to develop and die from cancer than any other racial or ethnic group. The aims of this research were to: (1) evaluate current education materials being implemented in a community-based prostate cancer education program for AA communities; (2) refine materials based on findings from Aim 1; (3) share updated materials with participants from Aim 1 for additional improvements; and (4) disseminate and evaluate the improved education program through a statewide videoconference with AA men and women. AA individuals evaluated the current education program through a mail survey (n=32) and community forum (n=38). Participants reported that the existing prostate cancer education program content could be understood by lay persons, but recommendations for improvement were identified. They included: defining unknown and/or scientific terminology, increasing readability by increasing font size and enlarging images, and including more recent and relevant statistics. Following refinement of the education materials based on survey and forum feedback, a statewide videoconference was implemented. Following the videoconference, participants (25 men; 3 women) reported that they would encourage others to learn more about prostate cancer, talk to their doctor about whether or not to get screened for prostate cancer, and would recommend the conference to others. There is great potential for using this type of iterative approach to education program development with community and clinical partners for others conducting similar work. PMID:25510370

Postdeployment military mental health training: cross-national evaluations.

PubMed

Foran, Heather M; Garber, Bryan G; Zamorski, Mark A; Wray, Mariane; Mulligan, Kathleen; Greenberg, Neil; Castro, Carl Andrew; Adler, Amy B

2013-05-01

Deployments increase risk for adjustment problems in service members. To mitigate this increased risk, mental health training programs have been developed and implemented in several nations. As part of a coordinated effort, three nations adapted a U.S. mental health training program that had been validated by a series of group randomized trials demonstrating improvement in postdeployment adjustment. Implementation of evidence-based programs in a new context is challenging: How much of the original program needs to remain intact in order to retain its utility? User satisfaction rates can provide essential data to assess how well a program is accepted. This article summarizes service member ratings of postdeployment mental health training and compares ratings from service members across four nations. The participating nations (Canada, New Zealand, United Kingdom, and the United States) administered mental health training to active duty military personnel in their respective nations. Following the training, military personnel completed an evaluation of the training. Overall, across the four nations, more than 70% of military personnel agreed or strongly agreed that they were satisfied with the mental health training. Although some differences in evaluations were observed across nations, components of training that were most important to overall satisfaction with the training were strikingly similar across nations. Fundamentally, it appears feasible that despite cultural and organizational differences, a mental health training program developed in one nation can be successfully adapted for use in other nations. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Core curricula for postdoctoral dental students: recent problems, potential solutions, and a model for the future.

PubMed

Iacopino, Anthony M; Taft, Thomas B

2007-11-01

Development of common core curricula for the graduate advanced education/specialty programs in dental schools presents significant challenges. Similarities in graduate education accreditation standards justify such an approach, yet a core curriculum is difficult to achieve for a variety of reasons including scheduling constraints and the capacity of a common, single pathway curriculum to address the specific educational needs of postgraduate students in different disciplines. Additionally, many dental schools are experiencing severe shortages of qualified faculty to provide graduate program instruction. There are no previous reports regarding graduate core curricula and the definition/delivery of such core curricula in advanced education programs in dentistry although there are several reports in the medical literature that support the educational value of a unified core curriculum implemented in a modular format. Graduate curricula are typically designed to provide residents with advanced education/training beyond what is acquired during their predoctoral dental school experience. Advanced education programs must emphasize knowledge and skills that are discipline-specific; however, there is a large amount of common foundational material within the early phases of these programs. Dental schools have attempted to identify and present this common material within the context of an organized shared set of courses/seminars where residents from each advanced education program are scheduled simultaneously. However, there have been problems with the implementation of a shared core curricula including the following: 1) dissimilar educational backgrounds/abilities among residents; 2) relevance of material to all residents; 3) lack of central management; 4) scheduling conflicts; and 5) lack of adequate and consistent program evaluation. In an attempt to resolve these problems, a new comprehensive graduate core curriculum was implemented at the Marquette University School of Dentistry in 2000. This core curriculum was designed to 1) be user-friendly; 2) allow flexibility; 3) meet specific programmatic/accreditation needs for each advanced education program; and 4) provide assessment tools for continuous resident feedback and curriculum improvement. Assessment data obtained from residents, faculty, and program directors indicate that this approach has been successful and has transformed graduate education at Marquette. Thus, this model may prove useful for other institutions seeking to refine or develop graduate core curricula.

GCF Mark IV development

NASA Technical Reports Server (NTRS)

Mortensen, L. O.

1982-01-01

The Mark IV ground communication facility (GCF) as it is implemented to support the network consolidation program is reviewed. Changes in the GCF are made in the area of increased capacity. Common carrier circuits are the medium for data transfer. The message multiplexing in the Mark IV era differs from the Mark III era, in that all multiplexing is done in a GCF computer under GCF software control, which is similar to the multiplexing currently done in the high speed data subsystem.

The Application of Software Safety to the Constellation Program Launch Control System

NASA Technical Reports Server (NTRS)

Kania, James; Hill, Janice

2011-01-01

The application of software safety practices on the LCS project resulted in the successful implementation of the NASA Software Safety Standard NASA-STD-8719.138 and CxP software safety requirements. The GOP-GEN-GSW-011 Hazard Report was the first report developed at KSC to identify software hazard causes and their controls. This approach can be applied to similar large software - intensive systems where loss of control can lead to a hazard.

A unified approach for composite cost reporting and prediction in the ACT program

NASA Technical Reports Server (NTRS)

Freeman, W. Tom; Vosteen, Louis F.; Siddiqi, Shahid

1991-01-01

The Structures Technology Program Office (STPO) at NASA Langley Research Center has held two workshops with representatives from the commercial airframe companies to establish a plan for development of a standard cost reporting format and a cost prediction tool for conceptual and preliminary designers. This paper reviews the findings of the workshop representatives with a plan for implementation of their recommendations. The recommendations of the cost tracking and reporting committee will be implemented by reinstituting the collection of composite part fabrication data in a format similar to the DoD/NASA Structural Composites Fabrication Guide. The process of data collection will be automated by taking advantage of current technology with user friendly computer interfaces and electronic data transmission. Development of a conceptual and preliminary designers' cost prediction model will be initiated. The model will provide a technically sound method for evaluating the relative cost of different composite structural designs, fabrication processes, and assembly methods that can be compared to equivalent metallic parts or assemblies. The feasibility of developing cost prediction software in a modular form for interfacing with state of the art preliminary design tools and computer aided design (CAD) programs is assessed.

Implementation and Evaluation of a Life Narrative Interview Program for Medical Inpatients.

PubMed

Rybarczyk, Bruce; Garroway, Andrea Shamaskin-; Lanoye, Autumn; Griffin, Sarah; Bellg, Albert; Stone, Richard; Nelson, Sharon

2018-04-26

Two studies in the early 1990s demonstrated that life narrative interviews conducted by age-peer volunteers strengthened the coping of older patients undergoing invasive medical procedures. The present article reports on the implementation of a similar life narrative interview program for medical inpatients and subsequent evaluation of the mood and coping effects of the intervention. Three volunteers (mean age = 69 years) were trained to administer 45- to 60-minute life narrative interviews. Fifty-three inpatients (mean age = 70 years) on various units of a Mid-Atlantic non-profit hospital agreed to participate. The Positive and Negative Affect Schedule and Coping Self-Efficacy Inventory (CSEI) were administered before and after the interviews. T-tests indicated a significant increase in positive affect and decrease in negative affect following the interview but no changes in the CSEI. Patient satisfaction questions administered after the interview indicated that patients had a high level of satisfaction with the interview experience. The life narrative interview program appeared to improve the overall mood of participants while providing a satisfying activity to engage in while in the hospital. The project demonstrated a cost-effective method for employing volunteers to enhance the experience of patients at healthcare facilities.

Advancing Pharmacogenomics Education in the Core PharmD Curriculum through Student Personal Genomic Testing

PubMed Central

Adams, Solomon M.; Anderson, Kacey B.; Coons, James C.; Smith, Randall B.; Meyer, Susan M.; Parker, Lisa S.

2016-01-01

Objective. To develop, implement, and evaluate “Test2Learn” a program to enhance pharmacogenomics education through the use of personal genomic testing (PGT) and real genetic data. Design. One hundred twenty-two second-year doctor of pharmacy (PharmD) students in a required course were offered PGT as part of a larger program approach to teach pharmacogenomics within a robust ethical framework. The program added novel learning objectives, lecture materials, analysis tools, and exercises using individual-level and population-level genetic data. Outcomes were assessed with objective measures and pre/post survey instruments. Assessment. One hundred students (82%) underwent PGT. Knowledge significantly improved on multiple assessments. Genotyped students reported a greater increase in confidence in understanding test results by the end of the course. Similarly, undergoing PGT improved student’s self-perceived ability to empathize with patients compared to those not genotyped. Most students (71%) reported feeling PGT was an important part of the course, and 60% reported they had a better understanding of pharmacogenomics specifically because of the opportunity. Conclusion. Implementation of PGT in the core pharmacy curriculum was feasible, well-received, and enhanced student learning of pharmacogenomics. PMID:26941429

Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior.

PubMed

Czaja, Sara J; Valente, Thomas W; Nair, Sankaran N; Villamar, Juan A; Brown, C Hendricks

2016-05-17

Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings.

A model for improving the health and quality of life of single mothers in the developing world.

PubMed

Mainthia, Rajshri; Reppart, Laura; Reppart, Jim; Pearce, Elizabeth C; Cohen, Jordan J; Netterville, James L

2013-12-01

Among the impoverished population of coastal Kenya, there is a rapidly growing group of young single mothers who suffer from adverse health outcomes, incomplete schooling, social ostracism by their communities, and economic hardship. To address this problem, in 2008 the Single Mothers Program (SMP) selected a group of vulnerable single mothers, provided them with basic relief and education, equipped them with training and start-up capital to run their own businesses, and assessed the impact of the program via a pre- and post-implementation survey. After two years in the program, a majority of the single mothers increased their contraceptive use, increased their degree of literacy, increased their individual incomes, and were more positively perceived by their communities. This study demonstrates a program model that can be used to improve the health and quality of life of single mothers and their children in similar communities throughout the world.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs.

PubMed

Weiner, Bryan J; Lewis, Megan A; Linnan, Laura A

2009-04-01

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs.

Sporting programs for inactive population groups: factors influencing implementation in the organized sports setting.

PubMed

Ooms, Linda; Veenhof, Cindy; Schipper-van Veldhoven, Nicolette; de Bakker, Dinny H

2015-01-01

The organized sports sector has received increased attention as a setting to promote health-enhancing physical activity (HEPA) to the general population. For significant public health impact, it is important that successful HEPA programs are widely adopted, implemented and continued as ongoing practice. The importance of evaluating the context in which programs are implemented has been identified as critical. However, little research has focused on understanding the organized sports implementation context, including factors facilitating and impeding implementation. In this study, the main factors influencing implementation of HEPA programs in the organized sports setting were studied. Fourteen sporting programs in the Netherlands aimed at increasing participation in sports by inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were investigated. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands over a 3-year implementation period (June 2008-June 2011). The qualitative research component involved yearly face-to-face interviews (i.e. fourteen interviews each year, n = 12 program coordinators) and a group meeting with the program coordinators of the NSFs (n = 8). Cross-case comparisons and thematic analyses were performed to identify and categorize important facilitating and impeding factors respectively. The quantitative research component, used to identify the most important facilitating and impeding factors across all sporting programs, consisted of ranking of factors according to importance by the program coordinators (n = 12). Different factors act during six identified (implementation) phases. When comparing factors across phases, several key learnings were evident. Successful implementation relied, for example, on program design and enthusiastic individuals within sporting organizations. On the other hand, inactive people were hard to reach and participation of sports clubs was not self-evident. The findings were discussed in a broader context. This study adds to the knowledge base concerning the implementation of sporting programs, aimed at inactive people, in the organized sports setting. The main factors facilitating and impeding implementation were identified. The results of this study can be used by sports practitioners and policy makers when developing and implementing HEPA programs in this setting.

Community-Based Global Health Program for Maltreated Children and Adolescents in Brazil: The Equilibrium Program.

PubMed

Marques, Andrea Horvath; Oliveira, Paula Approbato; Scomparini, Luciana Burim; Silva, Uiara Maria Rêgo E; Silva, Angelica Cristine; Doretto, Victoria; de Medeiros Filho, Mauro Victor; Scivoletto, Sandra

2015-01-01

The maltreatment of children and adolescents is a global public health problem that affects high- and low-middle income countries ("LMICs"). In the United States, around 1.2 million children suffer from abuse, while in LMICs, such as Brazil, these rates are much higher (an estimated 28 million children). Exposition to early environmental stress has been associated with suboptimal physical and brain development, persistent cognitive impairment, and behavioral problems. Studies have reported that children exposed to maltreatment are at high risk of behavioral problems, learning disabilities, communication and psychiatric disorders, and general clinical conditions, such as obesity and systemic inflammation later in life. The aim of this paper is to describe The Equilibrium Program ("TEP"), a community-based global health program implemented in São Paulo, Brazil to serve traumatized and neglected children and adolescents. We will describe and discuss TEP's implementation, highlighting its innovation aspects, research projects developed within the program as well as its population profile. Finally, we will discuss TEP's social impact, challenges, and limitations. The program's goal is to promote the social and family reintegration of maltreated children and adolescents through an interdisciplinary intervention program that provides multi-dimensional bio-psycho-social treatment integrated with the diverse services needed to meet the unique demands of this population. The program's cost effectiveness is being evaluated to support the development of more effective treatments and to expand similar programs in other areas of Brazil. Policy makers should encourage early evidence-based interventions for disadvantaged children to promote healthier psychosocial environments and provide them opportunities to become healthy and productive adults. This approach has already shown itself to be a cost-effective strategy to prevent disease and promote health.

A capacity building approach to increase sports participation in disadvantaged urban communities: a multilevel analysis.

PubMed

Marlier, Mathieu; Cardon, Greet; De Bourdeaudhuij, Ilse; Willem, Annick

2014-12-01

Recent evidence showed that community capacity building is one of the key methods to reach health improvements within disadvantaged communities. Physical activity and sports participation are important means to reach health improvements. This study investigates a capacity building method which aims at increasing sports participation in the community, especially for individuals at higher risk of sports deprivation. The main aims of the present study, are the following: (1) to examine differences in sports participation between individuals living in communities implementing a sports-based capacity building program and individuals living in communities without such capacity building program and (2) to investigate if the community sports program reaches the individuals known to experience higher barriers to engage in sports. In Flanders, Belgium, five disadvantaged urban communities implementing the community capacity building program (program communities) and four without (control communities) were selected based on similarity of sociodemographic and environmental characteristics. Two hundred adults (aged 18-56 years) per community were randomly selected and visited at home to fill out a questionnaire on sociodemographics, sports participation, and the community sports program. A sample of 414 adults participated in the study. Results showed that adults from program communities reported on average 96 min/week more participation in sports than their counterparts living in control communities. Furthermore, 61.3% of the individuals of program communities indicated to engage in sports, whereas in control communities, this was only 42.4%. Respondents at higher risk of sports deprivation also engaged in significantly more sports participation in program communities than those in control communities. This difference was also noted for groups that are not related with sports deprivation. These results are promising and plead for a community capacity building approach to increase sports participation in disadvantaged communities.

Building Sustainable Professional Development Programs: Applying Strategies From Implementation Science to Translate Evidence Into Practice.

PubMed

Baldwin, Constance D; Chandran, Latha; Gusic, Maryellen E

2017-01-01

Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model. Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability. Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars. Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.

Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective.

PubMed

Pettersson, Fanny L M

2013-01-01

In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally. To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes. The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized. This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.

Space Station Freedom electrical power system hardware commonality with the United States Polar Platform

NASA Technical Reports Server (NTRS)

Rieker, Lorra L.; Haraburda, Francis M.

1989-01-01

The National Aeronautics and Space Administration has adopted the policy to achieve the maximum practical level of commonality for the Space Station Freedom program in order to significantly reduce life cycle costs. Commonality means using identical or similar hardware/software for meeting common sets of functionally similar requirements. Information on how the concept of commonality is being implemented with respect to electric power system hardware for the Space Station Freedom and the U.S. Polar Platform is presented. Included is a historical account of the candidate common items which have the potential to serve the same power system functions on both Freedom and the Polar Platform.

Green supply chain management in China

NASA Astrophysics Data System (ADS)

Zhu, Qinghua; Sarkis, Joseph

2004-02-01

Globalization results in both pressure and drivers for Chinese enterprise to improve their environmental performance. As a developing country, China has to balance economic and environmental performance. Green supply chain management (GSCM) is emerging to be an important approach for Chinese enterprises to improve performance, possibly on both these dimensions. Using empirical results from 89 respondents on GSCM practice in Chinese manufacturing enterprises, we examine the relationships between pressures, practice and performance. The results will look at multiple dimensions of GSCM practice and performance, as well as various pressures they face. Discussion of the results will include practical implications for organizations, not only in China, but internationally who face similar pressures and seek to implement similar programs.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

PubMed

Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

2017-08-01

The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Evaluation of a class wide teaching program for developing preschool life skills.

PubMed

Hanley, Gregory P; Heal, Nicole A; Tiger, Jeffrey H; Ingvarsson, Einar T

2007-01-01

Recently, nonmaternal center-based child care has been linked to problem behavior in young children (National Institute of Child Health and Human Development, 2003). In response, a comprehensive program to promote prosocial skills was evaluated in a classroom of 16 children between the ages of 3 and 5 years. Classroom observations were conducted during evocative situations to determine the likelihood of problem behavior (noncompliance, vocal or motor disruptions, aggression) and preschool life skills. A classwide teaching program was then implemented in a staggered manner across instruction following, functional communication, delay tolerance, and friendship skills. These four categories of preschool life skills, which included two to four related skills, were selected for classwide teaching because they were either identified by educators as important for early school success, have often been taught following functional assessments of more severe problem behavior, or both. Skills were taught on a classwide basis during typically scheduled activities (circle, free play, transitions, meals) via instructions, modeling, role play, and feedback. A multiple probe design showed that the program resulted in an 74% reduction in problem behavior and a more than four-fold increase in preschool life skills. Similar beneficial effects of the program were evident in questionnaire data gathered prior to and at the close of the evaluation. Finally, the teachers who implemented the program reported overall high levels of satisfaction with the classwide teaching program, the target skills, and the results. Implications for the design of early childhood experiences for preempting the development of serious problem behavior are discussed.

Evaluation of a Classwide Teaching Program for Developing Preschool Life Skills

PubMed Central

Hanley, Gregory P; Heal, Nicole A; Tiger, Jeffrey H; Ingvarsson, Einar T

2007-01-01

Recently, nonmaternal center-based child care has been linked to problem behavior in young children (National Institute of Child Health and Human Development, 2003). In response, a comprehensive program to promote prosocial skills was evaluated in a classroom of 16 children between the ages of 3 and 5 years. Classroom observations were conducted during evocative situations to determine the likelihood of problem behavior (noncompliance, vocal or motor disruptions, aggression) and preschool life skills. A classwide teaching program was then implemented in a staggered manner across instruction following, functional communication, delay tolerance, and friendship skills. These four categories of preschool life skills, which included two to four related skills, were selected for classwide teaching because they were either identified by educators as important for early school success, have often been taught following functional assessments of more severe problem behavior, or both. Skills were taught on a classwide basis during typically scheduled activities (circle, free play, transitions, meals) via instructions, modeling, role play, and feedback. A multiple probe design showed that the program resulted in an 74% reduction in problem behavior and a more than four-fold increase in preschool life skills. Similar beneficial effects of the program were evident in questionnaire data gathered prior to and at the close of the evaluation. Finally, the teachers who implemented the program reported overall high levels of satisfaction with the classwide teaching program, the target skills, and the results. Implications for the design of early childhood experiences for preempting the development of serious problem behavior are discussed. PMID:17624068

Development of a theory and evidence-based program to promote community treatment of fevers in children under five in a rural district in Southern Ghana: An intervention mapping approach.

PubMed

Abbey, Mercy; Bartholomew, L Kay; Chinbuah, Margaret A; Gyapong, Margaret; Gyapong, John O; van den Borne, Bart

2017-01-25

This paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five. Designed as a multicomponent program, the intervention comprises elements to influence the behavior of caregivers of children, Community Health Workers, professional health care providers and the wider community. Following the six fundamental steps of the Intervention Mapping protocol, we involved relevant stakeholders from the commencement of planning to program end. The IM protocol also recommends various behavior change methods to guide intervention development. The intervention components implemented were successful in achieving program goals. For example, the intervention resulted in the primary outcome of reductions in all-cause mortality of 30% and 44%, among children treated with an antimalarial and those treated with the antimalarial plus an antibiotic respectively. Most Community Health Workers were retained on the program, with an attrition rate of 21.2% over a period of 30 months and the Community Health Workers rate of adherence to performance guidelines was high at 94.6%. We were able to systematically develop a theory- and evidence-based health promotion program based on the Intervention Mapping protocol. This article contributes to the response to recent calls for a more detailed description of the development of interventions and trials. The intervention mapping approach can serve as a guide for others interested in developing community- based health interventions in similar settings.

The Indiana Chronic Disease Management Program's impact on medicaid claims: a longitudinal, statewide evaluation.

PubMed

Katz, Barry P; Holmes, Ann M; Stump, Timothy E; Downs, Steven M; Zillich, Alan J; Ackermann, Ronald T; Inui, Thomas S

2009-02-01

: Disease management programs have grown in popularity over the past decade as a strategy to curb escalating healthcare costs for persons with chronic diseases. : To evaluate the effect of the Indiana Chronic Disease Management Program (ICDMP) on the longitudinal changes in Medicaid claims statewide. : Phased implementation of a chronic disease management program in 3 regions of the state. Fourteen repeated cohorts of Medicaid members were drawn over a period of 3.5 years and the trends in claims were evaluated using a repeated measures model. : A total of 44,218 Medicaid members with diabetes and/or congestive heart failure in 3 geographic regions in Indiana. : Across all 3 regions and both disease classes, we found a flattening of cost trends between the pre- and post-ICDMP-initiation periods. This change in the slopes was significant for all of the models except for congestive heart failure in southern Indiana. Thus, the average per member claims paid was increasing at a faster rate before ICDMP but slowed once the program was initiated. To distinguish shorter and longer-term effects related to ICDMP, we estimated annual slopes within the pre- and post-ICDMP- time periods. A similar pattern was found in all regions: claims were increasing before ICDMP, flattened in the years around program initiation, and remained flat in the final year of follow-up. : This analysis shows that the trend in average total claims changed significantly after the implementation of ICDMP, with a decline in the rate of increase in claims paid observed for targeted Medicaid program populations across the state of Indiana.

Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer.

PubMed

Vargas, Roberto B; Ryan, Gery W; Jackson, Catherine A; Rodriguez, Rian; Freeman, Harold P

2008-07-15

Patient navigation is an intervention developed to reduce disparities in cancer care that is being widely replicated and receiving considerable support for demonstration projects and research to test its effectiveness. In the current study, the authors present an in-depth descriptive analysis of the original patient navigation programs to inform current and future program development. A qualitative multistakeholder case study using interviews and site visits of the first patient navigation site and 2 sites subsequently developed by the leadership of the original site were evaluated. At these sites, patient navigation is a system, as opposed to a person, comprised primarily of navigators and directors that work together to remove barriers and facilitate access in a well-defined course of care; navigators were from the community or were culturally similar to the patient population served but were also paid employees of the clinical care site with detailed knowledge of the clinical course patients must traverse to complete care plans. Directors had administrative authority over the clinical facility and social capital across institutions, and communicated regularly and openly with navigators to implement system level changes to remove barriers to care. Contextual factors such as policies supporting breast cancer care also influenced the implementation of these programs. The first patient navigation programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic, and poverty-driven disparities in care. Future efforts to replicate and evaluate patient navigation should take into account these unique aspects of the original patient navigation programs. (c) 2008 American Cancer Society.

CUDA compatible GPU cards as efficient hardware accelerators for Smith-Waterman sequence alignment

PubMed Central

Manavski, Svetlin A; Valle, Giorgio

2008-01-01

Background Searching for similarities in protein and DNA databases has become a routine procedure in Molecular Biology. The Smith-Waterman algorithm has been available for more than 25 years. It is based on a dynamic programming approach that explores all the possible alignments between two sequences; as a result it returns the optimal local alignment. Unfortunately, the computational cost is very high, requiring a number of operations proportional to the product of the length of two sequences. Furthermore, the exponential growth of protein and DNA databases makes the Smith-Waterman algorithm unrealistic for searching similarities in large sets of sequences. For these reasons heuristic approaches such as those implemented in FASTA and BLAST tend to be preferred, allowing faster execution times at the cost of reduced sensitivity. The main motivation of our work is to exploit the huge computational power of commonly available graphic cards, to develop high performance solutions for sequence alignment. Results In this paper we present what we believe is the fastest solution of the exact Smith-Waterman algorithm running on commodity hardware. It is implemented in the recently released CUDA programming environment by NVidia. CUDA allows direct access to the hardware primitives of the last-generation Graphics Processing Units (GPU) G80. Speeds of more than 3.5 GCUPS (Giga Cell Updates Per Second) are achieved on a workstation running two GeForce 8800 GTX. Exhaustive tests have been done to compare our implementation to SSEARCH and BLAST, running on a 3 GHz Intel Pentium IV processor. Our solution was also compared to a recently published GPU implementation and to a Single Instruction Multiple Data (SIMD) solution. These tests show that our implementation performs from 2 to 30 times faster than any other previous attempt available on commodity hardware. Conclusions The results show that graphic cards are now sufficiently advanced to be used as efficient hardware accelerators for sequence alignment. Their performance is better than any alternative available on commodity hardware platforms. The solution presented in this paper allows large scale alignments to be performed at low cost, using the exact Smith-Waterman algorithm instead of the largely adopted heuristic approaches. PMID:18387198

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

Prevalence and Implementation Fidelity of Research-Based Prevention Programs in Public Schools. Final Report

ERIC Educational Resources Information Center

Crosse, Scott; Williams, Barbara; Hagen, Carol A.; Harmon, Michele; Ristow, Liam; DiGaetano, Ralph; Broene, Pamela; Alexander, Debbie; Tseng, Margaret; Derzon, James H.

2011-01-01

This report presents descriptive information about the prevalence and quality of implementation of research-based programs from the Study of the Implementation of Research-Based Programs to Prevent Youth Substance Abuse and School Crime. The study found that, while schools reported implementing a large number of prevention programs during the…

Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

PubMed

Mohamed, Somaia

2013-03-01

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

Do Program Implementation Factors or Fidelity Affect Chronic Disease Self-Management Education Programs' Outcomes?

PubMed

Brady, Teresa J; Murphy, Louise B; O'Colmain, Benita J; Hobson, Reeti Desai

2017-09-01

To evaluate whether implementation factors or fidelity moderate chronic disease self-management education program outcomes. Meta-analysis of 34 Arthritis Self-Management Program and Chronic Disease Self-Management Program studies. Community. N = 10 792. Twelve implementation factors: program delivery fidelity and setting and leader and participant characteristics. Eighteen program outcomes: self-reported health behaviors, physical health status, psychological health status, and health-care utilization. Meta-analysis using pooled effect sizes. Modest to moderate statistically significant differences for 4 of 6 implementation factors; these findings were counterintuitive with better outcomes when leaders and participants were unpaid, leaders had less than minimum training, and implementation did not meet fidelity requirements. Exploratory study findings suggest that these interventions tolerate some variability in implementation factors. Further work is needed to identify key elements where fidelity is essential for intervention effectiveness.

Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS.

PubMed

Doran, Kelly; Resnick, Barbara; Kim, Natalie; Lynn, Donna; McCormick, Tyrell

2017-02-01

Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). The intervention is ongoing, but measures are described. As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing.... (4) A part 145 certificate holder who has your own drug testing program Obtain an Antidrug and...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... Specification, Letter of Authorization, or Drug and Alcohol Testing Program Registration from the FAA: If you...

14 CFR 120.117 - Implementing a drug testing program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Implementing a drug testing program. 120... AND ALCOHOL TESTING PROGRAM Drug Testing Program Requirements § 120.117 Implementing a drug testing... 145 certificate holder who has your own drug testing program Obtain an Antidrug and Alcohol Misuse...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Speer, B.; Koenig, R.

Under property-assessed clean energy (PACE) and similar programs, municipal financing districts lend the proceeds of bonds to property owners for financing energy retrofits. Property owners who invest in energy efficiency (EE) measures and small renewable energy (RE) systems then repay these loans over 15-20 years via annual assessments on their property tax bills. States and local governments can use PACE bonds to help property owners finance EE and RE projects. This factsheet outlines the benefits of PACE programs and describes how they can be designed, implemented, and funded. The factsheet also summarizes the benefits and challenges experienced by PACE programsmore » in Boulder County, Colorado; Annapolis, Maryland; Berkeley, California; Sonoma County, California; Palm Desert, California; and Babylon, New York.« less

Value-based insurance plus disease management increased medication use and produced savings.

PubMed

Gibson, Teresa B; Mahoney, John; Ranghell, Karlene; Cherney, Becky J; McElwee, Newell

2011-01-01

We evaluated the effects of implementing a value-based insurance design program for patients with diabetes in two groups within a single firm. One group participated in disease management; the other did not. We matched members of the two groups to similar enrollees within the company that did not offer the value-based program. We found that participation in both value-based insurance design and disease management resulted in sustained improvement over time. Use of diabetes medications increased 6.5 percent over three years. Adherence to diabetes medical guidelines also increased, producing a return on investment of $1.33 saved for every dollar spent during a three-year follow-up period.

Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All-Referral Neonatal Intensive Care Unit.

PubMed

Jadcherla, Sudarshan R; Dail, James; Malkar, Manish B; McClead, Richard; Kelleher, Kelly; Nelin, Leif

2016-07-01

We hypothesized that the implementation of a feeding quality improvement (QI) program among premature neonates accelerates feeding milestones, safely lowering hospital length of stay (LOS) compared with the baseline period. Baseline data were collected for 15 months (N = 92) prior to initiating the program, which involved development and implementation of a standardized feeding strategy in eligible premature neonates. Process optimization, implementation of feeding strategy, monitoring compliance, multidisciplinary feeding rounds, and continuous education strategies were employed. The main outcomes included the ability and duration to reach enteral feeds-120 (mL/kg/d), oral feeds-120 (mL/kg/d), and ad lib oral feeding. Balancing measures included growth velocities, comorbidities, and LOS. Comparing baseline versus feeding program (N = 92) groups, respectively, the feeding program improved the number of infants receiving trophic feeds (34% vs 80%, P < .002), trophic feeding duration (14.8 ± 10.3 days vs 7.6 ± 8.1 days, P < .0001), time to enteral feeds-120 (16.3 ± 15.4 days vs 11.4 ± 10.4 days, P < .04), time from oral feeding onset to oral feeds-120 (13.2 ± 16.7 days vs 19.5 ± 15.3 days, P < .0001), time from oral feeds-120 to ad lib feeds at discharge (22.4 ± 27.2 days vs 18.6 ± 21.3 days, P < .01), weight velocity (24 ± 6 g/d vs 27 ± 11 g/d, P < .03), and LOS (104.2 ± 51.8 vs 89.3 ± 46.0, P = .02). Mortality, readmissions within 30 days, and comorbidities were similar. Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities. © 2015 American Society for Parenteral and Enteral Nutrition.

Cost-effectiveness of Project ADAM: a project to prevent sudden cardiac death in high school students.

PubMed

Berger, S; Whitstone, B N; Frisbee, S J; Miner, J T; Dhala, A; Pirrallo, R G; Utech, L M; Sachdeva, R C

2004-01-01

Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.

The impact of middle manager affective commitment on perceived improvement program implementation success.

PubMed

Fryer, Ashley-Kay; Tucker, Anita L; Singer, Sara J

Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success. We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment. We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success. Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success. We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program. Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.

Opportunity for collaboration: a conceptual model of success in tobacco control and cancer prevention.

PubMed

Stillman, Frances A; Schmitt, Carol L; Rosas, Scott R

2012-01-01

Collaborations between cancer prevention and tobacco control programs can leverage scarce resources to address noncommunicable diseases globally, but barriers to cooperation and actual collaboration are substantial. To foster collaboration between cancer prevention and tobacco control programs, the Global Health Partnership conducted research to identify similarities and differences in how the 2 programs viewed program success. Using concept mapping, cancer prevention and tobacco control experts generated statements describing the components of a successful cancer prevention or tobacco control program and 33 participants sorted and rated the final 99 statements. Multidimensional scaling analysis with a 2-dimensional solution was used to identify an 8-cluster conceptual map of program success. We calculated Pearson correlation coefficients for all 99 statements to compare the item-level ratings of both groups and used t tests to compare the mean importance of ratings assigned to each cluster. Eight major clusters of success were identified: 1) advocacy and persuasion, 2) building sustainability, 3) partnerships, 4) readiness and support, 5) program management fundamentals, 6) monitoring and evaluation, 7) utilization of evidence, and 8) implementation. We found no significant difference between the maps created by the 2 groups and only 1 mean difference for the importance ratings for 1 of the clusters: cancer prevention experts rated partnerships as more important to program success than did tobacco control experts. Our findings are consistent with those of research documenting the necessary components of successful programs and the similarities between cancer prevention and tobacco control. Both programs value the same strategies to address a common risk factor: tobacco use. Identifying common ground between these 2 research and practice communities can benefit future collaborations at the local, state, tribal, national, and international levels, and inform the broader discussion on resource sharing among other organizations whose mission focuses on noncommunicable diseases.

Patient-centered health care using pharmacist-delivered medication therapy management in rural Mississippi.

PubMed

Ross, Leigh Ann; Bloodworth, Lauren S

2012-01-01

To describe and provide preliminary clinical and economic outcomes from a pharmacist-delivered patient-centered health care (PCHC) model implemented in the Mississippi Delta. Mississippi between July 2008 and June 2010. 13 community pharmacies in nine Mississippi Delta counties. This PCHC model implements a comprehensive medication therapy management (MTM) program with pharmacist training, individualized patient encounters and group education, provider outreach, integration of pharmacists into health information technology, and on-site support in community pharmacies in a medically underserved region with a large burden of chronic disease and health disparities. The program also expands on traditional MTM services through initiatives in health literacy/cultural competency and efforts to increase the provider network and improve access to care. Criteria-based clinical outcomes, quality indicator reports, cost avoidance. PCHC services have been implemented in 13 pharmacies in nine counties in this underserved region, and 78 pharmacists and 177 students have completed the American Pharmacists Association's MTM Certificate Training Program. Preliminary data from 468 patients showed 681 encounters in which 1,471 drug therapy problems were identified and resolved. Preliminary data for clinical indicators and economic outcome measures are trending in a positive direction. Preliminary data analyses suggest that pharmacist-provided PCHC is beneficial and has the potential to be replicated in similar rural communities that are plagued with chronic disease and traditional primary care provider shortages. This effort aligns with national priorities to reduce medication errors, improve health outcomes, and reduce health care costs in underserved communities.

An implementation of the programming structural synthesis system (PROSSS)

NASA Technical Reports Server (NTRS)

Rogers, J. L., Jr.; Sobieszczanski-Sobieski, J.; Bhat, R. B.

1981-01-01

A particular implementation of the programming structural synthesis system (PROSSS) is described. This software system combines a state of the art optimization program, a production level structural analysis program, and user supplied, problem dependent interface programs. These programs are combined using standard command language features existing in modern computer operating systems. PROSSS is explained in general with respect to this implementation along with the steps for the preparation of the programs and input data. Each component of the system is described in detail with annotated listings for clarification. The components include options, procedures, programs and subroutines, and data files as they pertain to this implementation. An example exercising each option in this implementation to allow the user to anticipate the type of results that might be expected is presented.

Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

PubMed

Theising, Katie M; Fritschle, Traci L; Scholfield, Angelina M; Hicks, Emily L; Schymik, Michelle L

2015-11-01

Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95% CI -18.59 to -7.73, p<0.05) from baseline to program completion was seen in systolic blood pressure, and the mean difference in diastolic blood pressure was -7 mm Hg (95% CI -9.92 to -4.04, p<0.05). This study demonstrated that health plan beneficiaries who participated in the employer-sponsored, pharmacist-provided MTM program had significant decreases in A1C and blood pressure. © 2015 Pharmacotherapy Publications, Inc.

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

PubMed

Rajan, Sonali; Roberts, Katherine J; Guerra, Laura; Pirsch, Moira; Morrell, Ernest

2017-12-01

School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains. © 2017, American School Health Association.

Building a global teledermatology collaboration.

PubMed

Bobbs, Melanie; Bayer, Michelle; Frazer, Tifany; Humphrey, Stephen; Wilson, Barbara; Olasz, Edit; Holland, Kristen; Kuzminski, Jacquelyn

2016-04-01

Skin disease is common in low-resource countries and is associated with significant morbidity. The disease burden is often heightened by lack of access to adequate diagnosis and treatment. Teledermatology is a growing healthcare delivery modality that allows access to subspecialty care at a distance. This article describes how a low-cost teledermatology program was launched through collaboration between the Medical College of Wisconsin and Hillside Healthcare International. Several factors are required for a teledermatology program to be successful, beginning with a partnership between two entities that targets a locally identified need and is mutually beneficial to invested partners. The program should utilize the expertise of each partner, be based on an agreed upon process with clearly defined objectives, and protect patient privacy. After a program is implemented, adaptation to address challenges and best meet the needs of all parties involved will allow for continued success and sustainability. This process can serve as a model for other programs desiring to establish similar teledermatology partnerships in an academic setting. © 2016 The International Society of Dermatology.

mobile Digital Access to a Web-enhanced Network (mDAWN): Assessing the Feasibility of Mobile Health Tools for Self-Management of Type-2 Diabetes.

PubMed

Ho, Kendall; Newton, Lana; Boothe, Allison; Novak-Lauscher, Helen

2015-01-01

The mobile Digital Access to a Web-enhanced Network (mDAWN) program was implemented as an online, mobile self-management system to support patients with type-2 diabetes and their informal caregivers. Patients used wireless physiological sensors, received text messages, and had access to a secure web platform with health resources and semi-facilitated discussion forum. Outcomes were evaluated using (1) pre and post self-reported health behavior measures, (2) physiological outcomes, (3) program cost, and (4) in-depth participant interviews. The group had significantly decreased health distress, HbA1c levels, and systolic blood pressure. Participants largely saw the mDAWN as providing good value for the costs involved and found the program to be empowering in gaining control over their diabetes. mHealth programs have the potential to improve clinical outcomes through cost effective patient-led care for chronic illness. Further evaluation needs to examine integration of similar mHealth programs into the patient-physician relationship.

Fellowships in community pharmacy research: Experiences of five schools and colleges of pharmacy.

PubMed

Snyder, Margie E; Frail, Caitlin K; Gernant, Stephanie A; Bacci, Jennifer L; Coley, Kim C; Colip, Lauren M; Ferreri, Stefanie P; Hagemeier, Nicholas E; McGivney, Melissa Somma; Rodis, Jennifer L; Smith, Megan G; Smith, Randall B

2016-01-01

To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Five schools and colleges of pharmacy in the United States. Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

PubMed Central

Snyder, Margie E.; Frail, Caitlin K.; Gernant, Stephanie A.; Bacci, Jennifer L.; Coley, Kim C.; Colip, Lauren M.; Ferreri, Stefanie P.; Hagemeier, Nicholas E.; McGivney, Melissa Somma; Rodis, Jennifer L.; Smith, Megan G.; Smith, Randall B.

2017-01-01

Objective To describe common facilitators, challenges, and lessons learned of five schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting Five schools and colleges of pharmacy in the United States. Practice Description Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice Innovation Community pharmacy fellowships, each structured as two years in length and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill and The Ohio State University. Evaluation Program directors from each of the five community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results Common characteristics across the programs include length of training, pre-requisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n=4) have been successful in securing pharmacy faculty positions. Conclusion Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice. PMID:27083852

Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

PubMed

Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

2016-03-01

Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

A Framework for Identifying Implementation Issues Affecting Extension Human Sciences Programming

ERIC Educational Resources Information Center

Abell, Ellen; Cummings, Rebekah; Duke, Adrienne M.; Marshall, Jennifer Wells

2015-01-01

Extension programs based on identified needs, relevant theory, and solid research too often fail to realize their objectives. Program implementation is acknowledged to contribute to program effectiveness, yet systematic attention has not been paid to the array of implementation issues that can complicate achieving program goals. We developed the…

Implementing three evidence-based program models: early lessons from the Teen Pregnancy Prevention Replication Study.

PubMed

Kelsey, Meredith; Layzer, Jean

2014-03-01

This article describes some of the early implementation challenges faced by nine grantees participating in the Teen Pregnancy Prevention Replication Study and their response to them. The article draws on information collected as part of a comprehensive implementation study. Sources include site and program documents; program officer reports; notes from site investigation, selection and negotiation; ongoing communications with grantees as part of putting the study into place; and semi-structured interviews with program staff. The issues faced by grantees in implementing evidence-based programs designed to prevent teen pregnancy varied by program model. Grantees implementing a classroom-based curriculum faced challenges in delivering the curriculum within the constraints of school schedules and calendars (program length and size of class). Grantees implementing a culturally tailored curriculum faced a series of challenges, including implementing the intervention as part of the regular school curriculum in schools with diverse populations; low attendance when delivered as an after-school program; and resistance on the part of schools to specific curriculum content. The third set of grantees, implementing a program in clinics, faced challenges in identifying and recruiting young women into the program and in retaining young women once they were in the program. The experiences of these grantees reflect some of the complexities that should be carefully considered when choosing to replicate evidence-based programs. The Teen Pregnancy Prevention replication study will provide important context for assessing the effectiveness of some of the more widely replicated evidence-based programs. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program.

PubMed

Dennis, Sarah; Hetherington, Sharon A; Borodzicz, Jerrad A; Hermiz, Oshana; Zwar, Nicholas A

2015-04-01

Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program. Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically. Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas. Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers

PubMed Central

Dariotis, Jacinda K.; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T.; Mendelson, Tamar

2016-01-01

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators – students and their classroom teachers – merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings. PMID:28670007

A Qualitative Exploration of Implementation Factors in a School-Based Mindfulness and Yoga Program: Lessons Learned from Students and Teachers.

PubMed

Dariotis, Jacinda K; Mirabal-Beltran, Roxanne; Cluxton-Keller, Fallon; Gould, Laura Feagans; Greenberg, Mark T; Mendelson, Tamar

2017-01-01

Identifying factors relevant for successful implementation of school-based interventions is essential to ensure that programs are provided in an effective and engaging manner. The perspectives of two key stakeholders critical for identifying implementation barriers and facilitators - students and their classroom teachers - merit attention in this context and have rarely been explored using qualitative methods. This study reports qualitative perspectives of fifth and sixth grade participants and their teachers of a 16-week school-based mindfulness and yoga program in three public schools serving low-income urban communities. Four themes related to program implementation barriers and facilitators emerged: program delivery factors, program buy-in, implementer communication with teachers, and instructor qualities. Feedback from students and teachers is discussed in the context of informing implementation, adaptation, and future development of school-based mindfulness and yoga programming in urban settings.

Development and Implementation of a Comprehensive Risk Management Program at the USAF Academy Hospital, USAF Academy, Colorado

DTIC Science & Technology

1980-04-01

injuries annually of which some 700,000 appeared to involve some form of medically negligent conduct. 6 Similarly, the number of malpractice claims brought...only three (3) claims of medical malpractice were filed against the Air Force. That same year, a total of $12(!) was paid by the Air Force in...1976.26 The department of Health, Education and Welfare’s Commission on Medical Malpractice estimated that 12,000 medical malpractice claims 27 were filed

National Fuel Cell Bus Program: Accelerated Testing Evaluation Report and Appendices, Alameda-Contra Costa Transit District (AC Transit)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chandler, K.; Eudy, L.

2009-01-01

This is an evaluation of hydrogen fuel cell transit buses operating at AC Transit in revenue service since March 20, 2006 compared to similar diesel buses operating from the same depot. This evaluation report includes results from November 2007 through October 2008. Evaluation results include implementation experience, fueling station operation, fuel cell bus operations at Golden Gate Transit, and evaluation results at AC Transit (bus usage, availability, fuel economy, maintenance costs, and roadcalls).

National Fuel Cell Bus Program: Accelerated Testing Evaluation Report #2, Alameda-Contra Costa Transit District (AC Transit) and Appendices

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eudy, L.; Chandler, K.

2010-06-01

This is an evaluation of hydrogen fuel cell transit buses operating at AC Transit in revenue service since March 20, 2006, comparing similar diesel buses operating from the same depot. It covers November 2007 through February 2010. Results include implementation experience, fueling station operation, evaluation results at AC Transit (bus usage, availability, fuel economy, maintenance costs, and road calls), and a summary of achievements and challenges encountered during the demonstration.

Quarterly Technical Progress Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mary K. Banken

This project has identified all FDD oil reservoirs in Oklahoma; grouped those reservoirs into plays that have similar depositional origins; collected, organized, and analyzed all available data; conducted characterization and simulation studies on selected reservoirs in each plays; and implemented a technology transfer program targeted to the operators of FDD reservoirs. By fulfilling these objectives, the FDD project has had the goal of helping to sustain the life expectancy of existing wells and provide incentive for development and exploratory wells with the ultimate objective of increasing oil recovery.

Defense Infrastructure: Guam Needs Timely Information from DOD to Meet Challenges in Planning and Financing Off-Base Projects and Programs to Support a Larger Military Presence

DTIC Science & Technology

2009-11-13

plan to guide the civilian community as a result of rapid military growth • Designing, testing, and implementation of an econometric model to...continue. 17 48 U.S.C. § 1423a. Most U.S. states and local municipalities have similar...additional revenue. For instance, Guam receives federal income taxes paid by military and civilian employees of the U.S. government stationed in Guam.22

Developmental milestones across the programmatic life cycle: implementing the CDC's Colorectal Cancer Screening Demonstration Program.

PubMed

Glover-Kudon, Rebecca; DeGroff, Amy; Rohan, Elizabeth A; Preissle, Judith; Boehm, Jennifer E

2013-08-01

In 2005 through 2009, the Centers for Disease Control and Prevention (CDC) funded 5 sites to implement a colorectal cancer screening program for uninsured, low-income populations. These 5 sites composed a demonstration project intended to explore the feasibility of establishing a national colorectal cancer screening program through various service delivery models. A longitudinal, multiple case study was conducted to understand and document program implementation processes. Using metaphor as a qualitative analytic technique, evaluators identified stages of maturation across the programmatic life cycle. Analysis rendered a working theory of program development during screening implementation. In early stages, program staff built relationships with CDC and local partners around screening readiness, faced real-world challenges putting program policies into practice, revised initial program designs, and developed new professional skills. Midterm implementation was defined by establishing program cohesiveness and expanding programmatic reach. In later stages of implementation, staff focused on sustainability and formal program closeout, which prompted reflection about personal and programmatic accomplishments. Demonstration sites evolved through common developmental stages during screening implementation. Findings elucidate ways to target technical assistance to more efficiently move programs along their maturation trajectory. In practical terms, the time and cost associated with guiding a program to maturity may be potentially shortened to maximize return on investment for both organizations and clients receiving service benefits. © 2013 American Cancer Society.

IPM: Integrated Pest Management Kit for Building Managers. How To Implement an Integrated Pest Management Program in Your Building(s).

ERIC Educational Resources Information Center

Mitchell, Brad

This management kit introduces building managers to the concept of Integrated Pest Management (IPM), and provides the knowledge and tools needed to implement an IPM program in their buildings. It discusses the barriers to implementing an IPM program, why such a program should be used, and the general guidelines for its implementation. Managerial…

Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives.

PubMed

Afendulis, Christopher C; Hatfield, Laura A; Landon, Bruce E; Gruber, Jonathan; Landrum, Mary Beth; Mechanic, Robert E; Zinner, Darren E; Chernew, Michael E

2017-03-01

In 2011 CareFirst BlueCross BlueShield, a large mid-Atlantic health insurance plan, implemented a payment and delivery system reform program. The model, called the Total Care and Cost Improvement Program, includes enhanced payments for primary care, significant financial incentives for primary care physicians to control spending, and care coordination tools to support progress toward the goal of higher-quality and lower-cost patient care. We conducted a mixed-methods evaluation of the initiative's first three years. Our quantitative analyses used spending and utilization data for 2010-13 to compare enrollees who received care from participating physician groups to similar enrollees cared for by nonparticipating groups. Savings were small and fully shared with providers, which suggests no significant effect on total spending (including bonuses). Our qualitative analysis suggested that early in the program, many physicians were not fully engaged with the initiative and did not make full use of its tools. These findings imply that this and similar payment reforms may require greater time to realize significant savings than many stakeholders had expected. Patience may be necessary if payer-led reform is going to lead to system transformation. Project HOPE—The People-to-People Health Foundation, Inc.

75 FR 48934 - Coral Reef Conservation Program Implementation Guidelines

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...-01] RIN 0648-ZC19 Coral Reef Conservation Program Implementation Guidelines AGENCY: National Oceanic... Guidelines (Guidelines) for the Coral Reef Conservation Program (CRCP or Program) under the Coral Reef... assistance for coral reef conservation projects under the Act. NOAA revised the Implementation Guidelines for...

36 CFR 230.21 - Implementation of the program.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 230.21 Section 230.21 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND PRIVATE FORESTRY ASSISTANCE Urban and Community Forestry Assistance Program § 230.21 Implementation of the program. (a) The Urban and Community Forestry Assistance Program is implemented through the...

The US Air Force suicide prevention program: implications for public health policy.

PubMed

Knox, Kerry L; Pflanz, Steven; Talcott, Gerald W; Campise, Rick L; Lavigne, Jill E; Bajorska, Alina; Tu, Xin; Caine, Eric D

2010-12-01

We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities.

Impact of a provincial asthma guidelines continuing medical education project: The Ontario Asthma Plan of Action’s Provider Education in Asthma Care Project

PubMed Central

Lougheed, M Diane; Moosa, Dilshad; Finlayson, Shelagh; Hopman, Wilma M; Quinn, Mallory; Szpiro, Kim; Reisman, Joseph

2007-01-01

BACKGROUND: The Ontario Ministry of Health and Long-Term Care funded the Ontario Lung Association to develop and implement a continuing medical education program to promote implementation of the Canadian asthma guidelines in primary care. OBJECTIVES: To determine baseline knowledge, preferred learning format, satisfaction with the program and reported impact on practice patterns. METHODS: A 3 h workshop was developed that combined didactic presentations and small group case discussions. Outcome measures included a workshop evaluation, baseline assessment of asthma management knowledge and three-month postreflective evaluations. RESULTS: One hundred thirty-seven workshops were delivered to 2783 primary care providers (1313 physicians, 1470 allied health) between September 2002 and March 2005. Of the 2133 participants, 1007 physicians and 1126 allied health professionals submitted workshop evaluations. Most (98%) of the attendees indicated they would recommend the workshop to a colleague. The majority preferred the combination of didactic lecture plus interactive case discussions. A subset of physicians provided consent to use these data for research (n=298 pediatric and 288 adult needs assessments; n=349 postreflective evaluations). Important needs identified included appropriate medication for chronic asthma and development of written action plans. On the postreflective evaluations, 88.7% remained very satisfied, 95.5% reported increased confidence, 91.9% reported an influence on practice and 67.2% reported using a written action plan. CONCLUSIONS: This continuing medical education program addresses identified needs of primary care providers. Participants reported improvements in asthma care, including prescribing practices, use of spirometry and written action plans. Similar programs should be considered as part of multifaceted asthma guidelines dissemination and implementation initiatives in other provinces and nationally. PMID:17372639

Preventing recurrent ankle sprains: Is the use of an App more cost-effective than a printed Booklet? Results of a RCT.

PubMed

Van Reijen, M; Vriend, I; van Mechelen, W; Verhagen, E A

2018-02-01

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

RevBayes: Bayesian Phylogenetic Inference Using Graphical Models and an Interactive Model-Specification Language

PubMed Central

Höhna, Sebastian; Landis, Michael J.

2016-01-01

Programs for Bayesian inference of phylogeny currently implement a unique and fixed suite of models. Consequently, users of these software packages are simultaneously forced to use a number of programs for a given study, while also lacking the freedom to explore models that have not been implemented by the developers of those programs. We developed a new open-source software package, RevBayes, to address these problems. RevBayes is entirely based on probabilistic graphical models, a powerful generic framework for specifying and analyzing statistical models. Phylogenetic-graphical models can be specified interactively in RevBayes, piece by piece, using a new succinct and intuitive language called Rev. Rev is similar to the R language and the BUGS model-specification language, and should be easy to learn for most users. The strength of RevBayes is the simplicity with which one can design, specify, and implement new and complex models. Fortunately, this tremendous flexibility does not come at the cost of slower computation; as we demonstrate, RevBayes outperforms competing software for several standard analyses. Compared with other programs, RevBayes has fewer black-box elements. Users need to explicitly specify each part of the model and analysis. Although this explicitness may initially be unfamiliar, we are convinced that this transparency will improve understanding of phylogenetic models in our field. Moreover, it will motivate the search for improvements to existing methods by brazenly exposing the model choices that we make to critical scrutiny. RevBayes is freely available at http://www.RevBayes.com. [Bayesian inference; Graphical models; MCMC; statistical phylogenetics.] PMID:27235697

RevBayes: Bayesian Phylogenetic Inference Using Graphical Models and an Interactive Model-Specification Language.

PubMed

Höhna, Sebastian; Landis, Michael J; Heath, Tracy A; Boussau, Bastien; Lartillot, Nicolas; Moore, Brian R; Huelsenbeck, John P; Ronquist, Fredrik

2016-07-01

Programs for Bayesian inference of phylogeny currently implement a unique and fixed suite of models. Consequently, users of these software packages are simultaneously forced to use a number of programs for a given study, while also lacking the freedom to explore models that have not been implemented by the developers of those programs. We developed a new open-source software package, RevBayes, to address these problems. RevBayes is entirely based on probabilistic graphical models, a powerful generic framework for specifying and analyzing statistical models. Phylogenetic-graphical models can be specified interactively in RevBayes, piece by piece, using a new succinct and intuitive language called Rev. Rev is similar to the R language and the BUGS model-specification language, and should be easy to learn for most users. The strength of RevBayes is the simplicity with which one can design, specify, and implement new and complex models. Fortunately, this tremendous flexibility does not come at the cost of slower computation; as we demonstrate, RevBayes outperforms competing software for several standard analyses. Compared with other programs, RevBayes has fewer black-box elements. Users need to explicitly specify each part of the model and analysis. Although this explicitness may initially be unfamiliar, we are convinced that this transparency will improve understanding of phylogenetic models in our field. Moreover, it will motivate the search for improvements to existing methods by brazenly exposing the model choices that we make to critical scrutiny. RevBayes is freely available at http://www.RevBayes.com [Bayesian inference; Graphical models; MCMC; statistical phylogenetics.]. © The Author(s) 2016. Published by Oxford University Press, on behalf of the Society of Systematic Biologists.

Embedding research to improve program implementation in Latin America and the Caribbean.

PubMed

Tran, Nhan; Langlois, Etienne V; Reveiz, Ludovic; Varallyay, Ilona; Elias, Vanessa; Mancuso, Arielle; Becerra-Posada, Francisco; Ghaffar, Abdul

2017-06-08

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

Study of the effect on shelter cat intakes and euthanasia from a shelter neuter return project of 10,080 cats from March 2010 to June 2014.

PubMed

Johnson, Karen L; Cicirelli, Jon

2014-01-01

Cat impoundments were increasing at the municipal San Jose animal shelter in 2009, despite long-term successful low cost sterilization programs and attempts to lower the euthanasia rate of treatable-rehabilitatable impounds beginning in 2008. San Jose Animal Care and Services implemented a new strategy designed to control overall feral cat reproduction by altering and returning feral cats entering the shelter system, rather than euthanizing the cats. The purpose of this case study was to determine how the program affected the shelter cat intakes over time. In just over four years, 10,080 individual healthy adult feral cats, out of 11,423 impounded at the shelter during this time frame, were altered and returned to their site of capture. Included in the 11,423 cats were 862 cats impounded from one to four additional times for a total of 958 (9.5%) recaptures of the previously altered 10,080 cats. The remaining 385 healthy feral cats were euthanized at the shelter from March 2010 to June 2014. Four years into the program, researchers observed cat and kitten impounds decreased 29.1%; euthanasia decreased from over 70% of intakes in 2009, to 23% in 2014. Euthanasia in the shelter for Upper Respiratory Disease decreased 99%; dead cat pick up off the streets declined 20%. Dog impounds did not similarly decline over the four years. No other laws or program changes were implemented since the beginning of the program.

The Development, Implementation, and Assessment of an Innovative Faculty Mentoring Leadership Program

PubMed Central

Tsen, Lawrence C.; Borus, Jonathan F.; Nadelson, Carol C.; Seely, Ellen W.; Haas, Audrey; Fuhlbrigge, Anne L.

2014-01-01

Effective mentoring is an important component of academic success. Few programs exist to both improve the effectiveness of established mentors and cultivate a multi-specialty mentoring community. In 2008, in response to a faculty survey on mentoring, leaders at Brigham and Women’s Hospital developed the Faculty Mentoring Leadership Program (FMLP) as a peer-learning experience for mid-career and senior faculty physician and scientist mentors to enhance their skills and leadership in mentoring and create a supportive community of mentors. A planning group representing key administrative, educational, clinical, and research mentorship constituencies designed the nine-month course. Participants met monthly for an hour and a half during lunchtime. Two co-facilitators engaged the diverse group of 16 participants in interactive discussions about cases based on the participants’ experiences. While the co-facilitators discussed with the participants the dyadic mentor-mentee relationship, they specifically emphasized the value of engaging multiple mentors and establishing mentoring networks. In response to post-session and post-course (both immediately and after six months) self-assessments, participants reported substantive gains in their mentoring confidence and effectiveness, experienced a renewed sense of enthusiasm for mentoring, and took initial steps to build a diverse network of mentoring relationships. In this article, the authors describe the rationale, design, implementation, assessment, and ongoing impact of this innovative faculty mentoring leadership program. They also share lessons learned for other institutions that are contemplating developing a similar faculty mentoring program. PMID:23095917

Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study.

PubMed

Dattalo, M; Wise, M; Ford Ii, J H; Abramson, B; Mahoney, J

2017-04-01

As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.

Factors related to leader implementation of a nationally disseminated community-based exercise program: a cross-sectional study

PubMed Central

Seguin, Rebecca A; Palombo, Ruth; Economos, Christina D; Hyatt, Raymond; Kuder, Julia; Nelson, Miriam E

2008-01-01

Background The benefits of community-based health programs are widely recognized. However, research examining factors related to community leaders' characteristics and roles in implementation is limited. Methods The purpose of this cross-sectional study was to use a social ecological framework of variables to explore and describe the relationships between socioeconomic, personal/behavioral, programmatic, leadership, and community-level social and demographic characteristics as they relate to the implementation of an evidence-based strength training program by community leaders. Eight-hundred fifty-four trained program leaders in 43 states were invited to participate in either an online or mail survey. Corresponding community-level characteristics were also collected. Programmatic details were obtained from those who implemented. Four-hundred eighty-seven program leaders responded to the survey (response rate = 57%), 78% online and 22% by mail. Results Of the 487 respondents, 270 implemented the program (55%). One or more factors from each category – professional, socioeconomic, personal/behavioral, and leadership characteristics – were significantly different between implementers and non-implementers, determined by chi square or student's t-tests as appropriate. Implementers reported higher levels of strength training participation, current and lifetime physical activity, perceived support, and leadership competence (all p < 0.05). Logistic regression analysis revealed a positive association between implementation and fitness credentials/certification (p = 0.003), program-specific self-efficacy (p = 0.002), and support-focused leadership (p = 0.006), and a negative association between implementation and educational attainment (p = 0.002). Conclusion Among this sample of trained leaders, several factors within the professional, socioeconomic, personal/behavioral, and leadership categories were related to whether they implemented a community-based exercise program. It may benefit future community-based physical activity program disseminations to consider these factors when selecting and training leaders. PMID:19055821

Engineering and Scientific Applications: Using MatLab(Registered Trademark) for Data Processing and Visualization

NASA Technical Reports Server (NTRS)

Sen, Syamal K.; Shaykhian, Gholam Ali

2011-01-01

MatLab(TradeMark)(MATrix LABoratory) is a numerical computation and simulation tool that is used by thousands Scientists and Engineers in many countries. MatLab does purely numerical calculations, which can be used as a glorified calculator or interpreter programming language; its real strength is in matrix manipulations. Computer algebra functionalities are achieved within the MatLab environment using "symbolic" toolbox. This feature is similar to computer algebra programs, provided by Maple or Mathematica to calculate with mathematical equations using symbolic operations. MatLab in its interpreter programming language form (command interface) is similar with well known programming languages such as C/C++, support data structures and cell arrays to define classes in object oriented programming. As such, MatLab is equipped with most of the essential constructs of a higher programming language. MatLab is packaged with an editor and debugging functionality useful to perform analysis of large MatLab programs and find errors. We believe there are many ways to approach real-world problems; prescribed methods to ensure foregoing solutions are incorporated in design and analysis of data processing and visualization can benefit engineers and scientist in gaining wider insight in actual implementation of their perspective experiments. This presentation will focus on data processing and visualizations aspects of engineering and scientific applications. Specifically, it will discuss methods and techniques to perform intermediate-level data processing covering engineering and scientific problems. MatLab programming techniques including reading various data files formats to produce customized publication-quality graphics, importing engineering and/or scientific data, organizing data in tabular format, exporting data to be used by other software programs such as Microsoft Excel, data presentation and visualization will be discussed.

Using systems science for population health management in primary care.

PubMed

Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

2014-10-01

Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years. Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

The Primary Prevention of PTSD in Firefighters: Preliminary Results of an RCT with 12-Month Follow-Up

PubMed Central

Rees, Clare S.; Mazzucchelli, Trevor G.; Kane, Robert T.

2016-01-01

Aim To develop and evaluate an evidence-based and theory driven program for the primary prevention of Post-traumatic Stress Disorder (PTSD). Design A pre-intervention / post-intervention / follow up control group design with clustered random allocation of participants to groups was used. The “control” group received “Training as Usual” (TAU). Method Participants were 45 career recruits within the recruit school at the Department of Fire and Emergency Services (DFES) in Western Australia. The intervention group received a four-hour resilience training intervention (Mental Agility and Psychological Strength training) as part of their recruit training school curriculum. Data was collected at baseline and at 6- and 12-months post intervention. Results We found no evidence that the intervention was effective in the primary prevention of mental health issues, nor did we find any significant impact of MAPS training on social support or coping strategies. A significant difference across conditions in trauma knowledge is indicative of some impact of the MAPS program. Conclusion While the key hypotheses were not supported, this study is the first randomised control trial investigating the primary prevention of PTSD. Practical barriers around the implementation of this program, including constraints within the recruit school, may inform the design and implementation of similar programs in the future. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001362583 PMID:27382968

Performance Audit of the U.S. Geological Survey, Energy Resource Program Inorganic Geochemistry Laboratory

USGS Publications Warehouse

Luppens, James A.; Janke, Louis G.; McCord, Jamey D.; Bullock, John H.; Brazeau, Lisa; Affronter, Ronald H.

2007-01-01

A performance audit of the U.S. Geological Survey (USGS), Energy Resource Program (ERP) Inorganic Geochemistry Laboratory (IGL) was conducted between August, 2003 and October, 2005. The goals were to ensure that a high level of analytical performance was maintained and identify any areas that could be enhanced. The audit was subdivided into three phases. Phase 1 was a preliminary assessment of current performance based on recent performance on CANSPEX samples. IGL performance was also compared to laboratories world-wide with similar scope. Phase 2 consisted of the implementation of the recommended changes made in Phase 1. Phase 3 of the audit consisted of a reassessment effort to evaluate the effectiveness of the recommendations made in the Phase 1 and an on-site audit of the laboratory facilities. Phases 1 and 3 required summary reports that are included in Appendices A and B of this report. The audit found that the IGL was one of the top two laboratories compared for trace element analyses. Several recommendations to enhance performance on major and minor elemental parameters were made and implemented. Demonstrated performance improvements as a result of the recommended changes were documented. Several initiatives to sustain the performance improvements gained from the audit have been implemented.

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... SOLID WASTE MANAGEMENT PLANS Resource Conservation and Resource Recovery Programs § 256.31 Recommendations for developing and implementing resource conservation and recovery programs. (a) In order to...

Strategic planning in an academic radiation medicine program.

PubMed

Hamilton, J L; Foxcroft, S; Moyo, E; Cooke-Lauder, J; Spence, T; Zahedi, P; Bezjak, A; Jaffray, D; Lam, C; Létourneau, D; Milosevic, M; Tsang, R; Wong, R; Liu, F F

2017-12-01

In this paper, we report on the process of strategic planning in the Radiation Medicine Program (rmp) at the Princess Margaret Cancer Centre. The rmp conducted a strategic planning exercise to ensure that program priorities reflect the current health care environment, enable nimble responses to the increasing burden of cancer, and guide program operations until 2020. Data collection was guided by a project charter that outlined the project goal and the roles and responsibilities of all participants. The process was managed by a multidisciplinary steering committee under the guidance of an external consultant and consisted of reviewing strategic planning documents from close collaborators and institutional partners, conducting interviews with key stakeholders, deploying a program-wide survey, facilitating an anonymous and confidential e-mail feedback box, and collecting information from group deliberations. The process of strategic planning took place from December 2014 to December 2015. Mission and vision statements were developed, and core values were defined. A final document, Strategic Roadmap to 2020, was established to guide programmatic pursuits during the ensuing 5 years, and an implementation plan was developed to guide the first year of operations. The strategic planning process provided an opportunity to mobilize staff talents and identify environmental opportunities, and helped to enable more effective use of resources in a rapidly changing health care environment. The process was valuable in allowing staff to consider and discuss the future, and in identifying strategic issues of the greatest importance to the program. Academic programs with similar mandates might find our report useful in guiding similar processes in their own organizations.

Strategic planning in an academic radiation medicine program

PubMed Central

Hamilton, J.L.; Foxcroft, S.; Moyo, E.; Cooke-Lauder, J.; Spence, T.; Zahedi, P.; Bezjak, A.; Jaffray, D.; Lam, C.; Létourneau, D.; Milosevic, M.; Tsang, R.; Wong, R.; Liu, F.F.

2017-01-01

Background In this paper, we report on the process of strategic planning in the Radiation Medicine Program (rmp) at the Princess Margaret Cancer Centre. The rmp conducted a strategic planning exercise to ensure that program priorities reflect the current health care environment, enable nimble responses to the increasing burden of cancer, and guide program operations until 2020. Methods Data collection was guided by a project charter that outlined the project goal and the roles and responsibilities of all participants. The process was managed by a multidisciplinary steering committee under the guidance of an external consultant and consisted of reviewing strategic planning documents from close collaborators and institutional partners, conducting interviews with key stakeholders, deploying a program-wide survey, facilitating an anonymous and confidential e-mail feedback box, and collecting information from group deliberations. Results The process of strategic planning took place from December 2014 to December 2015. Mission and vision statements were developed, and core values were defined. A final document, Strategic Roadmap to 2020, was established to guide programmatic pursuits during the ensuing 5 years, and an implementation plan was developed to guide the first year of operations. Conclusions The strategic planning process provided an opportunity to mobilize staff talents and identify environmental opportunities, and helped to enable more effective use of resources in a rapidly changing health care environment. The process was valuable in allowing staff to consider and discuss the future, and in identifying strategic issues of the greatest importance to the program. Academic programs with similar mandates might find our report useful in guiding similar processes in their own organizations. PMID:29270061

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

PubMed

Del Boca, Frances K; McRee, Bonnie; Vendetti, Janice; Damon, Donna

2017-02-01

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts. © 2017 Society for the Study of Addiction.

Implementation of an "after hours" resident educational program in a general surgery residency: a paradigm for increasing formal didactic training outside of the hospital setting in the era of the 80-hour workweek.

PubMed

Fields, Ryan C; Bowman, Michele C; Freeman, Bradley D; Klingensmith, Mary E

2009-01-01

Residency programs have been forced to curtail many educational activities to comply with duty-hour restrictions. We describe an "after hours" educational program as a forum to provide small-group education customized for each training level to compliment our formal curriculum. Sessions within each general surgery specialty were organized such that 1 session each month was open to either junior (R1 and R2) or senior (R3-R5) trainees and hosted by surgical faculty. Attendance was optional and limited to 15 residents per session with the format determined by the hosting faculty. Participants completed a postsession survey. Fourteen sessions were held during the 2008-2009 academic year. All sessions were >90% subscribed within 1 week of announcement and attendance was 88%. The average session duration was 2.6 +/- 0.4 hours. Junior resident sessions focused on preparing R1 and R2 residents to handle common consult questions; senior resident sessions were modeled as "mock oral boards." Resident and faculty responses to the postsession questionnaire were similar and favorable with respect to the educational value of this format. There is enthusiasm among faculty and trainees to provide small-group, level-specific educational programs outside of the hospital setting and the 80-hour workweek. Such a program is easily implemented, highly effective, and well received. This format has the added benefit of improving interaction between faculty and residents and increasing the camaraderie of a surgical training program.

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

PubMed

Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, J M

2017-01-01

COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention ( P <0.001). In addition, patients' mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 ( P <0.05). A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

78 FR 68390 - Fisheries of the Exclusive Economic Zone Off Alaska; Bering Sea and Aleutian Islands Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

...NMFS proposes regulations to implement Amendment 102 to the Fishery Management Plan for Groundfish of the Bering Sea and Aleutian Islands Management Area (BSAI FMP), and amend the Individual Fishing Quota Program for the Fixed-Gear Commercial Fisheries for Pacific Halibut and Sablefish in Waters in and off Alaska (IFQ Program). Amendment 102 and its proposed implementing regulations would create a Community Quota Entity (CQE) Program in halibut IFQ regulatory area 4B (Area 4B) and the sablefish Aleutian Islands regulatory area that is similar to the existing CQE Program in the Gulf of Alaska (GOA). Amendment 102 would also allow an eligible community in Area 4B and in the Aleutian Islands to establish a non-profit organization as a CQE to purchase halibut catcher vessel quota share (QS) assigned to Area 4B and sablefish QS assigned to the Aleutian Islands. The CQE could assign the resulting annual halibut and sablefish IFQ to participants according to defined CQE Program elements. An additional proposed revision to the IFQ Program regulations would allow IFQ derived from D share halibut QS to be fished on Category C vessels in Area 4B. These actions are necessary to provide additional fishing opportunities for residents of fishery dependent communities and sustain participation in the halibut and sablefish IFQ fisheries. These actions are intended to promote the goals and objectives of the Magnuson-Stevens Fishery Conservation and Management Act, the Northern Pacific Halibut Act of 1982, the BSAI FMP, and other applicable law.

Implementing corporate wellness programs: a business approach to program planning.

PubMed

Helmer, D C; Dunn, L M; Eaton, K; Macedonio, C; Lubritz, L

1995-11-01

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

Institutional Readiness for Interprofessional Education Among Nutrition and Dietetics and Athletic Training Education Programs.

PubMed

Eliot, Kathrin; Breitbach, Anthony; Wilson, Mardell; Chushak, Maria

2017-01-01

Organizations recommend interprofessional education (IPE) as a means of promoting collaborative patient-centered care. In turn, various external accreditors in the health professions have integrated IPE competencies into their standards. However, little is known about how athletic training (AT) and nutrition and dietetics (ND) have incorporated IPE into their educational programs. This study examined institutional factors that affect the level of IPE participation within ND and AT programs in the United States. The Interprofessional Education Assessment and Planning Instrument for Academic Institutions was distributed electronically to directors of accredited programs in ND and AT. In addition to gathering demographic information, survey questions addressed the institutions' level of involvement and commitment to IPE. Differences emerged between ND and AT programs for several items in the instrument. Factors that affected the differences included program level and academic unit in which the program resides. Results also suggest that ND and AT programs have similar levels of IPE participation, but there are great opportunities for growth. Institutional factors such resource commitment, academic unit type, and level of program may affect implementation and contribute to the development and success of IPE initiatives.

Twenty-five years of ecological recovery of East Fork Poplar Creek: review of environmental problems and remedial actions.

PubMed

Loar, James M; Stewart, Arthur J; Smith, John G

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

Twenty-Five Years of Ecological Recovery of East Fork Poplar Creek: Review of Environmental Problems and Remedial Actions

NASA Astrophysics Data System (ADS)

Loar, James M.; Stewart, Arthur J.; Smith, John G.

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

Implementing a Batterer's Intervention Program in a Correctional Setting: A Tertiary Prevention Model

ERIC Educational Resources Information Center

Yorke, Nada J.; Friedman, Bruce D.; Hurt, Pat

2010-01-01

This study discusses the pretest and posttest results of a batterer's intervention program (BIP) implemented within a California state prison substance abuse program (SAP), with a recommendation for further programs to be implemented within correctional institutions. The efficacy of utilizing correctional facilities to reach offenders who…

IMPLEMENTATION REVIEW LETTERS, 2002

EPA Science Inventory

The following letters provide a summary of the Environmental Protection Agencys comments regarding 2002 Implementation Review of nineteen estuary programs in the National Estuary Program. Various strengths within the programs included use of implementation progress and tracking s...

Implementation of a tobacco-free workplace program at a local mental health authority.

PubMed

Correa-Fernández, Virmarie; Wilson, William T; Shedrick, Deborah A; Kyburz, Bryce; L Samaha, Hannah; Stacey, Timothy; Williams, Teresa; Lam, Cho Y; Reitzel, Lorraine R

2017-06-01

Tobacco-free workplace policies that incorporate evidence-based practices can increase the reach and effectiveness of tobacco dependence treatment among underserved populations but may be underutilized due to limited knowledge about implementation processes. This paper describes the implementation of a comprehensive tobacco-free workplace program at a behavioral healthcare community center in Texas. The center participated in a tobacco-free workplace program implementation project that provided guidance and resources and allowed center autonomy in implementation. Six employee-based subcommittees guided implementation of program components including consumer and staff surveys, policy development, signage, tobacco use assessments, communication, and nicotine replacement distribution. Timeline development, successes, challenges, lessons learned, and sustainability initiatives are delineated. Concerns about the tobacco-free workplace policy from the center's staff and consumers were gradually replaced by strong support for the initiative. Program success was enabled by consistent support from the center's leadership, publicity of program efforts, and educational campaigns. The center surpassed the program expectations when it adopted a tobacco-free hiring policy, which was not an initial program goal. This center's path to a tobacco-free workplace provides an implementation and sustainability model for other behavioral health community centers and other organizations to become tobacco free.

Optimizing Implementation of Obesity Prevention Programs: A Qualitative Investigation Within a Large-Scale Randomized Controlled Trial.

PubMed

Kozica, Samantha L; Teede, Helena J; Harrison, Cheryce L; Klein, Ruth; Lombard, Catherine B

2016-01-01

The prevalence of obesity in rural and remote areas is elevated in comparison to urban populations, highlighting the need for interventions targeting obesity prevention in these settings. Implementing evidence-based obesity prevention programs is challenging. This study aimed to investigate factors influencing the implementation of obesity prevention programs, including adoption, program delivery, community uptake, and continuation, specifically within rural settings. Nested within a large-scale randomized controlled trial, a qualitative exploratory approach was adopted, with purposive sampling techniques utilized, to recruit stakeholders from 41 small rural towns in Australia. In-depth semistructured interviews were conducted with clinical health professionals, health service managers, and local government employees. Open coding was completed independently by 2 investigators and thematic analysis undertaken. In-depth interviews revealed that obesity prevention programs were valued by the rural workforce. Program implementation is influenced by interrelated factors across: (1) contextual factors and (2) organizational capacity. Key recommendations to manage the challenges of implementing evidence-based programs focused on reducing program delivery costs, aided by the provision of a suite of implementation and evaluation resources. Informing the scale-up of future prevention programs, stakeholders highlighted the need to build local rural capacity through developing supportive university partnerships, generating local program ownership and promoting active feedback to all program partners. We demonstrate that the rural workforce places a high value on obesity prevention programs. Our results inform the future scale-up of obesity prevention programs, providing an improved understanding of strategies to optimize implementation of evidence-based prevention programs. © 2015 National Rural Health Association.

Training School Personnel to Implement a Universal School-Based Prevention of Depression Program under Real-World Conditions

ERIC Educational Resources Information Center

Harnett, P.H.; Dadds, M.R.

2004-01-01

The present study evaluated the impact of a universal prevention of depression program [the Resourceful Adolescent Program (RAP)] when implemented under real-world conditions in a school setting. Prior research has found the RAP program to be beneficial for high-school students when the program was implemented by university staff selected,…

A theory-informed approach to mental health care capacity building for pharmacists.

PubMed

Murphy, Andrea L; Gardner, David M; Kutcher, Stan P; Martin-Misener, Ruth

2014-01-01

Pharmacists are knowledgeable, accessible health care professionals who can provide services that improve outcomes in mental health care. Various challenges and opportunities can exist in pharmacy practice to hinder or support pharmacists' efforts. We used a theory-informed approach to development and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. Theories and frameworks including the Consolidated Framework for Implementation Research, the Theoretical Domains Framework, and the Behaviour Change Wheel were used to inform the conceptualization, development, and implementation of a capacity-building program to enhance pharmacists' roles in mental health care. The More Than Meds program was developed and implemented through an iterative process. The main program components included: an education and training day; use of a train-the-trainer approach from partnerships with pharmacists and people with lived experience of mental illness; development of a community of practice through email communications, a website, and a newsletter; and use of educational outreach delivered by pharmacists. Theories and frameworks used throughout the program's development and implementation facilitated a means to conceptualize the component parts of the program as well as its overall presence as a whole from inception through evolution in implementation. Using theoretical foundations for the program enabled critical consideration and understanding of issues related to trialability and adaptability of the program. Theory was essential to the underlying development and implementation of a capacity-building program for enhancing services by pharmacists for people with lived experience of mental illness. Lessons learned from the development and implementation of this program are informing current research and evolution of the program.

Crescendo: A Protein Sequence Database Search Engine for Tandem Mass Spectra.

PubMed

Wang, Jianqi; Zhang, Yajie; Yu, Yonghao

2015-07-01

A search engine that discovers more peptides reliably is essential to the progress of the computational proteomics. We propose two new scoring functions (L- and P-scores), which aim to capture similar characteristics of a peptide-spectrum match (PSM) as Sequest and Comet do. Crescendo, introduced here, is a software program that implements these two scores for peptide identification. We applied Crescendo to test datasets and compared its performance with widely used search engines, including Mascot, Sequest, and Comet. The results indicate that Crescendo identifies a similar or larger number of peptides at various predefined false discovery rates (FDR). Importantly, it also provides a better separation between the true and decoy PSMs, warranting the future development of a companion post-processing filtering algorithm.

Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

PubMed Central

Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

2004-01-01

This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

A program for thai rubber tappers to improve the cost of occupational health and safety.

PubMed

Arphorn, Sara; Chaonasuan, Porntip; Pruktharathikul, Vichai; Singhakajen, Vajira; Chaikittiporn, Chalermchai

2010-01-01

The purposes of this research were to determine the cost of occupational health and safety and work-related health problems, accidents, injuries and illnesses in rubber tappers by implementing a program in which rubber tappers were provided training on self-care in order to reduce and prevent work-related accidents, injuries and illnesses. Data on costs for healthcare, the prevention and the treatment of work-related accidents, injuries and illnesses were collected by interview using a questionnaire. The findings revealed that there was no relationship between what was spent on healthcare and the prevention of work-related accidents, injuries and illnesses and that spent on the treatment of work-related accidents, injuries and illnesses. The proportion of the injured subjects after the program implementation was significantly less than that before the program implementation (p<0.001). The level of pain after the program implementation was significantly less than that before the program implementation (p<0.05). The treatment costs incurred after the program implementation were significantly less than those incurred before the program implementation (p<0.001). It was demonstrated that this program raised the health awareness of rubber tappers. It strongly empowered the leadership in health promotion for the community.

Brazilian Scientific Mobility Program - Science without Borders - Preliminary Results and Perspectives.

PubMed

McManus, Concepta; Nobre, Carlos A

2017-05-01

The Brazilian Scientific Mobility Program - Science without Borders (SwB) - saw the concession of over 101 thousand scholarships for Brazilian STEM students and education professionals to attend universities worldwide. As the first phase of this program ends, it is time to take a first look at its impacts, mainly on the undergraduate student body (79% of total scholarships implemented). Benefits included a 6-month language course (optional), a one year undergraduate course and optional 2 month internship in a university, government laboratory or technology company. Positive impacts have been seen on entrance into post-graduate programs (>20% of SwB students compared to <5% of the overall student body of similar fields), as well as high representation of lower income families (>50% from families with less than 6 minimum wages per month). The impact of the program will need to be evaluated over the next years, but innovation on the part of the students is already apparent. Any new SwB program needs to take into account the lessons learned from this first experience and therefore recommendations are presented.

Reducing the Volume of NASA Earth-Science Data

NASA Technical Reports Server (NTRS)

Lee, Seungwon; Braverman, Amy J.; Guillaume, Alexandre

2010-01-01

A computer program reduces data generated by NASA Earth-science missions into representative clusters characterized by centroids and membership information, thereby reducing the large volume of data to a level more amenable to analysis. The program effects an autonomous data-reduction/clustering process to produce a representative distribution and joint relationships of the data, without assuming a specific type of distribution and relationship and without resorting to domain-specific knowledge about the data. The program implements a combination of a data-reduction algorithm known as the entropy-constrained vector quantization (ECVQ) and an optimization algorithm known as the differential evolution (DE). The combination of algorithms generates the Pareto front of clustering solutions that presents the compromise between the quality of the reduced data and the degree of reduction. Similar prior data-reduction computer programs utilize only a clustering algorithm, the parameters of which are tuned manually by users. In the present program, autonomous optimization of the parameters by means of the DE supplants the manual tuning of the parameters. Thus, the program determines the best set of clustering solutions without human intervention.

The Causality Study of External Environment Analysis (EEA), Internal Environment Analysis (IEA), Strategy Implementation on Study Program Performance at Vocational High School (VHS) in Nias Archipelago, Indonesia

ERIC Educational Resources Information Center

Waruwu, Binahati; Sitompul, Harun; Manullang, Belferik

2016-01-01

The purposes of this study are to find out the significant effect of: (1) EEA on strategy implementation, (2) IEA on strategy implementation, (3) EEA on study program performance, (4) IEA on study program performance, and (5) strategy implementation on study program performance of Vocational High School (VHS) in Nias Archipelago. The population of…

Parallel mutual information estimation for inferring gene regulatory networks on GPUs

PubMed Central

2011-01-01

Background Mutual information is a measure of similarity between two variables. It has been widely used in various application domains including computational biology, machine learning, statistics, image processing, and financial computing. Previously used simple histogram based mutual information estimators lack the precision in quality compared to kernel based methods. The recently introduced B-spline function based mutual information estimation method is competitive to the kernel based methods in terms of quality but at a lower computational complexity. Results We present a new approach to accelerate the B-spline function based mutual information estimation algorithm with commodity graphics hardware. To derive an efficient mapping onto this type of architecture, we have used the Compute Unified Device Architecture (CUDA) programming model to design and implement a new parallel algorithm. Our implementation, called CUDA-MI, can achieve speedups of up to 82 using double precision on a single GPU compared to a multi-threaded implementation on a quad-core CPU for large microarray datasets. We have used the results obtained by CUDA-MI to infer gene regulatory networks (GRNs) from microarray data. The comparisons to existing methods including ARACNE and TINGe show that CUDA-MI produces GRNs of higher quality in less time. Conclusions CUDA-MI is publicly available open-source software, written in CUDA and C++ programming languages. It obtains significant speedup over sequential multi-threaded implementation by fully exploiting the compute capability of commonly used CUDA-enabled low-cost GPUs. PMID:21672264

Community-Based Global Health Program for Maltreated Children and Adolescents in Brazil: The Equilibrium Program

PubMed Central

Marques, Andrea Horvath; Oliveira, Paula Approbato; Scomparini, Luciana Burim; Silva, Uiara Maria Rêgo e; Silva, Angelica Cristine; Doretto, Victoria; de Medeiros Filho, Mauro Victor; Scivoletto, Sandra

2015-01-01

The maltreatment of children and adolescents is a global public health problem that affects high- and low-middle income countries (“LMICs”). In the United States, around 1.2 million children suffer from abuse, while in LMICs, such as Brazil, these rates are much higher (an estimated 28 million children). Exposition to early environmental stress has been associated with suboptimal physical and brain development, persistent cognitive impairment, and behavioral problems. Studies have reported that children exposed to maltreatment are at high risk of behavioral problems, learning disabilities, communication and psychiatric disorders, and general clinical conditions, such as obesity and systemic inflammation later in life. The aim of this paper is to describe The Equilibrium Program (“TEP”), a community-based global health program implemented in São Paulo, Brazil to serve traumatized and neglected children and adolescents. We will describe and discuss TEP’s implementation, highlighting its innovation aspects, research projects developed within the program as well as its population profile. Finally, we will discuss TEP’s social impact, challenges, and limitations. The program’s goal is to promote the social and family reintegration of maltreated children and adolescents through an interdisciplinary intervention program that provides multi-dimensional bio-psycho-social treatment integrated with the diverse services needed to meet the unique demands of this population. The program’s cost effectiveness is being evaluated to support the development of more effective treatments and to expand similar programs in other areas of Brazil. Policy makers should encourage early evidence-based interventions for disadvantaged children to promote healthier psychosocial environments and provide them opportunities to become healthy and productive adults. This approach has already shown itself to be a cost-effective strategy to prevent disease and promote health. PMID:26283972

Insights into an Award-Winning Summer Internship Program: The First Six Years.

PubMed

Kashou, Anthony; Durairajanayagam, Damayanthi; Agarwal, Ashok

2016-04-01

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program.

Insights into an Award-Winning Summer Internship Program: The First Six Years

PubMed Central

Kashou, Anthony; Durairajanayagam, Damayanthi

2016-01-01

Since its inception in 2008, the American Center for Reproductive Medicine's summer internship program in reproductive research and writing has trained 114 students from 23 states within the United States and 10 countries worldwide. Its fundamental goal is to inspire pre-medical and medical students to embrace a career as a physician-scientist. During this intensive course, established scientists and clinicians train interns in the essential principles and fundamental concepts of bench research and scientific writing. Over the first six years (2008~2013), interns have collectively published 98 research articles and performed 12 bench research projects on current and emerging topics in reproductive medicine. Interns have also developed and honed valuable soft skills including time management, communication and presentation skills, as well as life values, which all enhance personal and professional satisfaction. Program graduates are able to recognize the value of medical research and its potential to impact patient care and gain insight into their own career pathway. Between 2011 and 2014, the internship program was thrice awarded a Scholarship in Teaching Award by Case Western Reserve School of Medicine for its innovative teaching approach and positive impact on medical education and student careers. This report highlights the demographics, logistics, implementation, feedback, and results of the first six years of the American Center for Reproductive Medicine's summer internship program at Cleveland Clinic (Cleveland, OH, USA). This may be helpful to other research and academic institutions considering implementing a similar program. In addition, it creates awareness among potential physician-scientists of what the world of research has to offer in both scientific writing and bench research. Finally, it may stimulate further discussion regarding narrowing the gap between physicians and scientists and refinement of the current program. PMID:27169124

Monitored Natural Attenuation as a Remediation Strategy for Nuclear Power Plant Applications

NASA Astrophysics Data System (ADS)

Kim, K.; Bushart, S.

2009-12-01

A NRC Information Notice (IN 2006-13) was produced to inform holders of nuclear operating licenses “of the occurrence of radioactive contamination of ground water at multiple facilities due to undetected leakage from facility structures, systems, or components (SSCs) that contain or transport radioactive fluids” so that they could consider actions, as appropriate, to avoid similar problems. To reinforce their commitment to environmental stewardship the nuclear energy industry has committed to improving management of situations that have the potential to lead to the inadvertent release of radioactive fluids. This Industry Groundwater Protection Initiative, finalized in June 2007 as [NEI 07-07], calls for implementation and improvement of on-site groundwater monitoring programs and enhanced communications with stakeholders and regulators about situations related to inadvertent releases. EPRI developed its Groundwater Protection Program to provide the nuclear energy industry with the technical support needed to implement the Industry Groundwater Initiative. An objective of the EPRI Groundwater Protection Program is to provide the nuclear industry with technically sound guidance for implementing and enhancing on-site groundwater monitoring programs. EPRI, in collaboration with the EPRI Groundwater Protection Committee of utility members, developed the EPRI Groundwater Protection Guidelines for Nuclear Power Plants (EPRI Report 1015118, November 2007), which provides site-specific guidance for implementing a technically sound groundwater monitoring program. The guidance applies a graded approach for nuclear plants to tailor a technically effective and cost efficient groundwater monitoring program to the site’s hydrogeology and risk for groundwater contamination. As part of the Groundwater Protection Program, EPRI is also investigating innovative remediation technologies for addressing low-level radioactive contamination in soils and groundwater at nuclear power plant sites. One of these remediation technologies is monitored natural attenuation (MNA), which has been widely used in other industries for the remediation of contaminants in soil and groundwater. Monitored natural attenuation (MNA) is a non-intervention, but not a no-action, groundwater and soil remediation approach that involves monitoring the dilution, dispersion, and decay of contaminants to meet remediation objectives. MNA has been commonly applied at sites where soil and groundwater have been contaminated by volatile organic compounds. This method has also been applied to remediation of radiological contamination at U.S. DOE facilities and decommissioning nuclear power plant sites. The EPRI published report (1016764) provides guidance for implementing MNA at nuclear power plants for remediation of radiological contaminants in groundwater and soil. The goal of the EPRI Groundwater Protection program is to bring together experience and technologies - both from within the nuclear industry and other industries - to support the industry’s commitment to environmental stewardship. Results from the program are being published in an extensive series of reports and software, and are being communicated to members in an annual EPRI Groundwater Protection technical exchange workshop.

Adapting and implementing an evidence-based sun-safety education program in rural Idaho, 2012.

PubMed

Cariou, Charlene; Gonzales, Melanie; Krebill, Hope

2014-05-08

Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke's Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support.

Adapting and Implementing an Evidence-Based Sun-Safety Education Program in Rural Idaho, 2012

PubMed Central

Gonzales, Melanie; Krebill, Hope

2014-01-01

Background Melanoma incidence and mortality rates in Idaho are higher than national averages. The importance of increased awareness of skin cancer has been cited by state and local organizations. St. Luke’s Mountain States Tumor Institute (MSTI) prioritized educational outreach efforts to focus on the implementation of a skin cancer prevention program in rural Idaho. Community Context As a community cancer center, MSTI expanded cancer education services to include dedicated support to rural communities. Through this expansion, an MSTI educator sought to partner with a community organization to provide sun-safety education. MSTI selected, adapted, and implemented an evidence-based program, Pool Cool. Methods The education program was implemented in 5 phases. In Phase I, we identified and recruited a community partner; in Phase 2, after thorough research, we selected a program, Pool Cool; in Phase 3, we planned the details of the program, including identification of desired short- and long-term outcomes and adaptation of existing program materials; in Phase 4, we implemented the program in summer 2012; in Phase 5, we assessed program sustainability and expansion. Outcome MSTI developed a sustainable partnership with Payette Municipal Pool, and in summer 2012, we implemented Pool Cool. Sun-safety education was provided to more than 700 young people aged 2 to 17 years, and educational signage and sunscreen benefitted hundreds of additional pool patrons. Interpretation Community cancer centers are increasingly being asked to assess community needs and implement evidence-based prevention and screening programs. Clinical staff may become facilitators of evidence-based public health programs. Challenges of implementing evidence-based programs in the context of a community cancer centers are staffing, leveraging of resources, and ongoing training and support. PMID:24809363

The changing context of Western European healthcare systems: convergence versus divergence in nursing problematics.

PubMed

Spitzer, Ada; Camus, Didier; Desaulles, Cécile; Kuhne, Nicolas

2006-10-01

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.

Using Tutte polynomials to analyze the structure of the benzodiazepines

NASA Astrophysics Data System (ADS)

Cadavid Muñoz, Juan José

2014-05-01

Graph theory in general and Tutte polynomials in particular, are implemented for analyzing the chemical structure of the benzodiazepines. Similarity analysis are used with the Tutte polynomials for finding other molecules that are similar to the benzodiazepines and therefore that might show similar psycho-active actions for medical purpose, in order to evade the drawbacks associated to the benzodiazepines based medicine. For each type of benzodiazepines, Tutte polynomials are computed and some numeric characteristics are obtained, such as the number of spanning trees and the number of spanning forests. Computations are done using the computer algebra Maple's GraphTheory package. The obtained analytical results are of great importance in pharmaceutical engineering. As a future research line, the usage of the chemistry computational program named Spartan, will be used to extent and compare it with the obtained results from the Tutte polynomials of benzodiazepines.

Implementation Measurement for Evidence-Based Violence Prevention Programs in Communities.

PubMed

Massetti, Greta M; Holland, Kristin M; Gorman-Smith, Deborah

2016-08-01

Increasing attention to the evaluation, dissemination, and implementation of evidence-based programs (EBPs) has led to significant advancements in the science of community-based violence prevention. One of the prevailing challenges in moving from science to community involves implementing EBPs and strategies with quality. The CDC-funded National Centers of Excellence in Youth Violence Prevention (YVPCs) partner with communities to implement a comprehensive community-based strategy to prevent violence and to evaluate that strategy for impact on community-wide rates of violence. As part of their implementation approach, YVPCs document implementation of and fidelity to the components of the comprehensive youth violence prevention strategy. We describe the strategies and methods used by the six YVPCs to assess implementation and to use implementation data to inform program improvement efforts. The information presented describes the approach and measurement strategies employed by each center and for each program implemented in the partner communities. YVPCs employ both established and innovative strategies for measurement and tracking of implementation across a broad range of programs, practices, and strategies. The work of the YVPCs highlights the need to use data to understand the relationship between implementation of EBPs and youth violence outcomes.

How To Implement a Tech Prep Program Based on the Rhode Island Model. Tech Prep Associate Degree Program. Technical Programs. Business/Office Administration Programs. Allied Health/Dental Health Programs.

ERIC Educational Resources Information Center

Community Coll. of Rhode Island, Warwick.

This implementation guide contains information based on experiences that occurred during the development and implementation of the Rhode Island Tech Prep Model. It is intended to assist educators in addressing challenges and obstacles faced by the program early in the planning process. It begins with a rationale for tech prep. Rhode Island…

Detecting selection effects in community implementations of family-based substance abuse prevention programs.

PubMed

Hill, Laura G; Goates, Scott G; Rosenman, Robert

2010-04-01

To calculate valid estimates of the costs and benefits of substance abuse prevention programs, selection effects must be identified and corrected. A supplemental comparison sample is typically used for this purpose, but in community-based program implementations, such a sample is often not available. We present an evaluation design and analytic approach that can be used in program evaluations of real-world implementations to identify selection effects, which in turn can help inform recruitment strategies, pinpoint possible selection influences on measured program outcomes, and refine estimates of program costs and benefits. We illustrate our approach with data from a multisite implementation of a popular substance abuse prevention program. Our results indicate that the program's participants differed significantly from the population at large.

Linking secondary school physical education with community sport and recreation for girls: a process evaluation.

PubMed

Casey, Meghan M; Telford, Amanda; Mooney, Amanda; Harvey, Jack T; Eime, Rochelle M; Payne, Warren R

2014-10-06

The purpose of this study was to undertake a process evaluation to examine the reach, adoption and implementation of a school-community linked physical activity (PA) program for girls aged 12 - 15 years (School Years 7 - 9) using the RE-AIM framework. Various approaches were used to assess 'reach', 'adoption' and implementation: (a) a school environment survey of intervention schools (n = 6); (b) teacher feedback regarding the professional development component (91.1% response rate) and lesson implementation (60.8% response rate); and (c) post-intervention focus group interviews with physical education (PE) teachers (n = 29), students (n = 125), coaches (n = 13) and instructors (n = 8) regarding program experiences. Reach and Adoption: Seven schools (n = 1491 Year 7-9 female student enrolment; 70% adoption rate), five tennis clubs, eight football clubs and five leisure centres participated in the program during 2011. Program design and professional development opportunities (training, resource manual and opportunities to work with coaches and instructors during PE classes) supported implementation and student engagement in PA. However, there was a lack of individual and organisational readiness to adopt program principles. For some deliverers there were deeply embedded ideologies that were not aligned with the Game Sense teaching approach upon which the program was based. Further, cognitive components of the program such as self-management were not widely adopted as other components of the program tended to be prioritised. The program design and resources supported the success of the program, however, some aspects were not implemented as intended, which may have affected the likelihood of achieving further positive outcomes. Barriers to program implementation were identified and should be considered when designing school-community linked interventions. In particular, future programs should seek to assess and adjust for organizational readiness within the study design. For example, shared commitment and abilities of program deliverers to implement the program needs to be determined to support program implementation. ACTRN12614000446662. April 30th 2014.

Staff Development in the Implementation of a Schoolwide Writing Program.

ERIC Educational Resources Information Center

Knudson, Ruth

A case study examined the implementation of a schoolwide writing program established in a California middle school through a district sponsored school improvement program (SIP). Conducted at an urban sprawl southern California school of approximately 900 students in grades seven and eight, the program was directed and implemented by the English…

Implementation of the Air Program Information Management System (APIMS) Inspection Module

DTIC Science & Technology

2009-05-01

7 5 T H A I R B A S E W I N G Implementation of the Air Program Information Management System (APIMS) Inspection Module 2009 Environment...Implementation of the Air Program Information Management System (APIMS) Inspection Module 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

The US Air Force Suicide Prevention Program: Implications for Public Health Policy

PubMed Central

Pflanz, Steven; Talcott, Gerald W.; Campise, Rick L.; Lavigne, Jill E.; Bajorska, Alina; Tu, Xin; Caine, Eric D.

2010-01-01

Objectives. We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. Methods. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Results. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. Conclusions. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities. PMID:20466973

Qualification of Daiichi Units 1, 2, and 3 Data for Severe Accident Evaluations - Process and Illustrative Examples from Prior TMI-2 Evaluations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rempe, Joy Lynn; Knudson, Darrell Lee

2014-09-01

The accidents at the Three Mile Island Unit 2 (TMI-2) Pressurized Water Reactor (PWR) and the Daiichi Units 1, 2, and 3 Boiling Water Reactors (BWRs) provide unique opportunities to evaluate instrumentation exposed to severe accident conditions. Conditions associated with the release of coolant and the hydrogen burn that occurred during the TMI-2 accident exposed instrumentation to harsh conditions, including direct radiation, radioactive contamination, and high humidity with elevated temperatures and pressures. As part of a program initiated in 2012 by the Department of Energy Office of Nuclear Energy (DOE-NE), a review was completed to gain insights from prior TMI-2more » sensor survivability and data qualification efforts. This initial review focused on the set of sensors deemed most important by post-TMI-2 instrumentation evaluation programs. Instrumentation evaluation programs focused on data required by TMI-2 operators to assess the condition of the reactor and containment and the effect of mitigating actions taken by these operators. In addition, prior efforts focused on sensors providing data required for subsequent forensic evaluations and accident simulations. To encourage the potential for similar activities to be completed for qualifying data from Daiichi Units 1, 2, and 3, this report provides additional details related to the formal process used to develop a qualified TMI-2 data base and presents data qualification details for three parameters: primary system pressure; containment building temperature; and containment pressure. As described within this report, sensor evaluations and data qualification required implementation of various processes, including comparisons with data from other sensors, analytical calculations, laboratory testing, and comparisons with sensors subjected to similar conditions in large-scale integral tests and with sensors that were similar in design to instruments easily removed from the TMI-2 plant for evaluations. As documented in this report, results from qualifying data for these parameters led to key insights related to TMI-2 accident progression. Hence, these selected examples illustrate the types of activities completed in the TMI-2 data qualification process and the importance of such a qualification effort. These details are documented in this report to facilitate implementation of similar process using data and examinations at the Daiichi Units 1, 2, and 3 reactors so that BWR-specific benefits can be obtained.« less

Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review.

PubMed

Casillas, Katherine L; Fauchier, Angèle; Derkash, Bridget T; Garrido, Edward F

2016-03-01

In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results. Copyright © 2015 Elsevier Ltd. All rights reserved.

Building capacity in implementation science research training at the University of Nairobi.

PubMed

Osanjo, George O; Oyugi, Julius O; Kibwage, Isaac O; Mwanda, Walter O; Ngugi, Elizabeth N; Otieno, Fredrick C; Ndege, Wycliffe; Child, Mara; Farquhar, Carey; Penner, Jeremy; Talib, Zohray; Kiarie, James N

2016-03-08

Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula.

Rational Selection, Criticality Assessment, and Tiering of Quality Attributes and Test Methods for Analytical Similarity Evaluation of Biosimilars.

PubMed

Vandekerckhove, Kristof; Seidl, Andreas; Gutka, Hiten; Kumar, Manish; Gratzl, Gyöngyi; Keire, David; Coffey, Todd; Kuehne, Henriette

2018-05-10

Leading regulatory agencies recommend biosimilar assessment to proceed in a stepwise fashion, starting with a detailed analytical comparison of the structural and functional properties of the proposed biosimilar and reference product. The degree of analytical similarity determines the degree of residual uncertainty that must be addressed through downstream in vivo studies. Substantive evidence of similarity from comprehensive analytical testing may justify a targeted clinical development plan, and thus enable a shorter path to licensing. The importance of a careful design of the analytical similarity study program therefore should not be underestimated. Designing a state-of-the-art analytical similarity study meeting current regulatory requirements in regions such as the USA and EU requires a methodical approach, consisting of specific steps that far precede the work on the actual analytical study protocol. This white paper discusses scientific and methodological considerations on the process of attribute and test method selection, criticality assessment, and subsequent assignment of analytical measures to US FDA's three tiers of analytical similarity assessment. Case examples of selection of critical quality attributes and analytical methods for similarity exercises are provided to illustrate the practical implementation of the principles discussed.

Beliefs and perceptions of mentorship among nursing faculty and traditional and accelerated undergraduate nursing students.

PubMed

Navarra, Ann-Margaret; Stimpfel, Amy Witkoski; Rodriguez, Karla; Lim, Fidelindo; Nelson, Noreen; Slater, Larry Z

2018-02-01

In order to meet the demands of a dynamic and complex health care landscape, nursing education must develop and implement programming to produce a highly educated nursing workforce. Interprofessional honors education in nursing with targeted mentorship is one such model. To describe undergraduate nursing student and faculty perceptions and beliefs of mentorship in the context of interprofessional honors education, and compare and contrast the perceptions and beliefs about mentorship in interprofessional honors education between undergraduate nursing students and faculty. The study used a cross-sectional, descriptive design. Data were collected at an urban university in the northeast US, using a researcher-developed electronic survey. The sample included 24 full-time nursing faculty, and 142 undergraduate nursing students. Perceptions and beliefs regarding mentorship in the context of interprofessional honors education were similar for faculty and students, with both ranking mentorship among the most important components of a successful honors program. Honors education with a dedicated mentorship component may be implemented to improve the undergraduate education experience, facilitate advanced degree attainment, and develop future nursing leaders. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extreme conditioning programs and injury risk in a US Army Brigade Combat Team.

PubMed

Grier, Tyson; Canham-Chervak, Michelle; McNulty, Vancil; Jones, Bruce H

2013-01-01

Brigades and battalions throughout the US Army are currently implementing a variety of exercise and conditioning programs with greater focus on preparation for mission-specific tasks. An Army physical therapy clinic working with a light infantry brigade developed the Advanced Tactical Athlete Conditioning (ATAC) program. The ATAC program is a unique physical training program consisting of high-intensity aquatic exercises, tactical agility circuits, combat core conditioning, and interval speed training. Along with ATAC, battalions have also incorporated components of fitness programs such as the Ranger Athlete Warrior program and CrossFit (Crossfit, Inc, Santa Monica, CA) an extreme conditioning program (ECP). To determine if these new programs (ATAC, ECP) had an effect on injury rates and physical fitness. Surveys were administered to collect personal characteristics, tobacco use, personal physical fitness training, Army physical fitness test results, and self-reported injuries. Medical record injury data were obtained 6 months before and 6 months after the implementation of the new program. Predictors of injury risk were assessed using multivariate logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Injury incidence among Soldiers increased 12% for overall injuries and 16% for overuse injuries after the implementation of the ATAC/ECPs. However, injury incidence among Soldiers not participating in ATAC/ECPs also increased 14% for overall injuries and 10% for overuse injuries. Risk factors associated with higher injury risk for Soldiers participating in ATAC/ECPs included: greater mileage run per week during unit physical training (OR (>16 miles per week÷≤7 miles per week)=2.24, 95% CI, 1.33-3.80); higher body mass index (BMI) (OR (BMI 25-29.9÷BMI<25)=1.77, 95% CI, 1.29-2.44), (OR (BMI =30÷BMI<25)=2.72, 95% CI, 1.67-4.43); cigarette use (OR (smoker÷nonsmoker)=1.80, 95% CI, 1.34-2.42); poor performance on the 2-mile run during the Army Physical Fitness Test (APFT) (OR (=15.51 minutes÷≤13.52 minutes)=1.76, 95% CI, 1.13-2.74); Injury risk was lower for those reporting resistance training, (OR (<1 time per week÷none)=0.53, 95% CI, 0.31-0.92), (OR (1-2 times per week÷none)=0.50, 95% CI, 0.29-0.84), (OR (≥3 times per week÷none)=0.45, 95% CI, 0.24-0.85). Given that Soldiers participating in ATAC/ECPs showed similar changes in injury rates compared to Soldiers not participating in ATAC/ECPs, no recommendation can be made for or against implementation of ATAC/ECPs.

Reference drug programs: effectiveness and policy implications.

PubMed

Schneeweiss, Sebastian

2007-04-01

In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies.

Reference drug programs: Effectiveness and policy implications☆

PubMed Central

Schneeweiss, Sebastian

2010-01-01

In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies. PMID:16777256

Implementation Challenges for Tier One and Tier Two School-Based Programs for Early Adolescents

ERIC Educational Resources Information Center

LaRusso, Maria D.; Donovan, Suzanne; Snow, Catherine

2016-01-01

This mixed-method study examined the implementation and the challenges to implementation for participants in randomized controlled trials of two school-based programs for early adolescents: the Tier One Word Generation (WG) program, and the Tier Two Strategic Adolescent Reading Intervention (STARI). Levels of implementation for WG and STARI varied…

Active Implementation Frameworks for Program Success: How to Use Implementation Science to Improve Outcomes for Children

ERIC Educational Resources Information Center

Metz, Allison; Bartley, Leah

2012-01-01

Over the past decade the science related to developing and identifying evidence-based programs and practices for children and families has improved significantly. However, the science related to implementing these programs in early childhood settings has lagged far behind. In this article, the authors outline how the science of implementation and…

Object Oriented Programming Systems (OOPS) and frame representations: An investigation of programming paradigms

NASA Technical Reports Server (NTRS)

Auty, David

1988-01-01

The project was initiated to research Object Oriented Programming Systems (OOPS) and frame representation systems, their significance and applicability, and their implementation in or relationship to Ada. Object orientated is currently a very popular conceptual adjective. Object oriented programming, in particular, is promoted as a particularly productive approach to programming; an approach which maximizes opportunities for code reuse and lends itself to the definition of convenient and well-developed units. Such units are thus expected to be usable in a variety of situations, beyond the typical highly specific unit development of other approaches. Frame represenation systems share a common heritage and similar conceptual foundations. Together they represent a quickly emerging alternative approach to programming. The approach is to first define the terms, starting with relevant concepts and using these to put bounds on what is meant by OOPS and Frames. From this the possibilities were pursued to merge OOPS with Ada which will further elucidate the significant characteristics which make up this programming approach. Finally, some of the merits and demerits of OOPS were briefly considered as a way of addressing the applicability of OOPS to various programming tasks.

The design and evaluation of a master of science program in anatomical sciences at Queen's University Canada.

PubMed

Kolomitro, Klodiana; MacKenzie, Leslie W; Wiercigroch, David; Godden, Lorraine

2018-05-15

The purpose of this study was to describe the design and evolution of a unique and successful Master of Science program in anatomical sciences at one Canadian post-secondary institution and to evaluate its long-term impact on student learning. This program prepares students to teach anatomy and design curricula in the anatomical sciences and is structured around three pillars of competency-content (disciplinary knowledge and transferable skills), pedagogy, and inquiry. Graduates of the program from the last ten years were surveyed, to better understand the knowledge, skills, and habits of mind they have adopted and implemented since completion. Interest was taken in identifying aspects of the program that students found particularly beneficial and areas that needed to be further developed. Based on the findings, this program has been a highly valuable experience for the graduates especially in helping them develop transferable skills, and grow as individuals. The hope is that other institutions that have similar programs in place or are considering developing them would benefit from this description of the program design and the sharing of the lessons learned. Anat Sci Educ. © 2018 American Association of Anatomists. © 2018 American Association of Anatomists.

Tempest: GPU-CPU computing for high-throughput database spectral matching.

PubMed

Milloy, Jeffrey A; Faherty, Brendan K; Gerber, Scott A

2012-07-06

Modern mass spectrometers are now capable of producing hundreds of thousands of tandem (MS/MS) spectra per experiment, making the translation of these fragmentation spectra into peptide matches a common bottleneck in proteomics research. When coupled with experimental designs that enrich for post-translational modifications such as phosphorylation and/or include isotopically labeled amino acids for quantification, additional burdens are placed on this computational infrastructure by shotgun sequencing. To address this issue, we have developed a new database searching program that utilizes the massively parallel compute capabilities of a graphical processing unit (GPU) to produce peptide spectral matches in a very high throughput fashion. Our program, named Tempest, combines efficient database digestion and MS/MS spectral indexing on a CPU with fast similarity scoring on a GPU. In our implementation, the entire similarity score, including the generation of full theoretical peptide candidate fragmentation spectra and its comparison to experimental spectra, is conducted on the GPU. Although Tempest uses the classical SEQUEST XCorr score as a primary metric for evaluating similarity for spectra collected at unit resolution, we have developed a new "Accelerated Score" for MS/MS spectra collected at high resolution that is based on a computationally inexpensive dot product but exhibits scoring accuracy similar to that of the classical XCorr. In our experience, Tempest provides compute-cluster level performance in an affordable desktop computer.

ASIC implementation of recursive scaled discrete cosine transform algorithm

NASA Astrophysics Data System (ADS)

On, Bill N.; Narasimhan, Sam; Huang, Victor K.

1994-05-01

A program to implement the Recursive Scaled Discrete Cosine Transform (DCT) algorithm as proposed by H. S. Hou has been undertaken at the Institute of Microelectronics. Implementation of the design was done using top-down design methodology with VHDL (VHSIC Hardware Description Language) for chip modeling. When the VHDL simulation has been satisfactorily completed, the design is synthesized into gates using a synthesis tool. The architecture of the design consists of two processing units together with a memory module for data storage and transpose. Each processing unit is composed of four pipelined stages which allow the internal clock to run at one-eighth (1/8) the speed of the pixel clock. Each stage operates on eight pixels in parallel. As the data flows through each stage, there are various adders and multipliers to transform them into the desired coefficients. The Scaled IDCT was implemented in a similar fashion with the adders and multipliers rearranged to perform the inverse DCT algorithm. The chip has been verified using Field Programmable Gate Array devices. The design is operational. The combination of fewer multiplications required and pipelined architecture give Hou's Recursive Scaled DCT good potential of achieving high performance at a low cost in using Very Large Scale Integration implementation.

Economic optimization of a global strategy to address the pandemic threat.

PubMed

Pike, Jamison; Bogich, Tiffany; Elwood, Sarah; Finnoff, David C; Daszak, Peter

2014-12-30

Emerging pandemics threaten global health and economies and are increasing in frequency. Globally coordinated strategies to combat pandemics, similar to current strategies that address climate change, are largely adaptive, in that they attempt to reduce the impact of a pathogen after it has emerged. However, like climate change, mitigation strategies have been developed that include programs to reduce the underlying drivers of pandemics, particularly animal-to-human disease transmission. Here, we use real options economic modeling of current globally coordinated adaptation strategies for pandemic prevention. We show that they would be optimally implemented within 27 y to reduce the annual rise of emerging infectious disease events by 50% at an estimated one-time cost of approximately $343.7 billion. We then analyze World Bank data on multilateral "One Health" pandemic mitigation programs. We find that, because most pandemics have animal origins, mitigation is a more cost-effective policy than business-as-usual adaptation programs, saving between $344.0.7 billion and $360.3 billion over the next 100 y if implemented today. We conclude that globally coordinated pandemic prevention policies need to be enacted urgently to be optimally effective and that strategies to mitigate pandemics by reducing the impact of their underlying drivers are likely to be more effective than business as usual.

Economic optimization of a global strategy to address the pandemic threat

PubMed Central

Pike, Jamison; Bogich, Tiffany; Elwood, Sarah; Finnoff, David C.; Daszak, Peter

2014-01-01

Emerging pandemics threaten global health and economies and are increasing in frequency. Globally coordinated strategies to combat pandemics, similar to current strategies that address climate change, are largely adaptive, in that they attempt to reduce the impact of a pathogen after it has emerged. However, like climate change, mitigation strategies have been developed that include programs to reduce the underlying drivers of pandemics, particularly animal-to-human disease transmission. Here, we use real options economic modeling of current globally coordinated adaptation strategies for pandemic prevention. We show that they would be optimally implemented within 27 y to reduce the annual rise of emerging infectious disease events by 50% at an estimated one-time cost of approximately $343.7 billion. We then analyze World Bank data on multilateral “One Health” pandemic mitigation programs. We find that, because most pandemics have animal origins, mitigation is a more cost-effective policy than business-as-usual adaptation programs, saving between $344.0.7 billion and $360.3 billion over the next 100 y if implemented today. We conclude that globally coordinated pandemic prevention policies need to be enacted urgently to be optimally effective and that strategies to mitigate pandemics by reducing the impact of their underlying drivers are likely to be more effective than business as usual. PMID:25512538

Integrating Technical Communication in the Mechanical Engineering Curriculum

NASA Astrophysics Data System (ADS)

Norberg, Seth; Ashcraft, Timothy; van Poppel, Bret

2017-11-01

Technical communication is essential to engineering practice, but these skills can be challenging to teach and assess in the classroom. Instructors in the Mechanical Engineering (ME) program at the United States Military Academy are developing new learning exercises to prepare students for success in their capstone design course and beyond. In this paper we highlight the recent successes and lessons learned from two courses: junior-level Thermal-Fluid Systems and the senior-level ME Seminar. Both courses support the newly implemented West Point Writing Program (WPWP), an institutional, writing-across-the-curriculum program. The junior course incorporates four hands-on experiments, which provide an abundance of data for students to analyze, assess, and present. In the senior course the majority of the content that students present is from their ongoing capstone design projects. Between the two courses, students craft essays, lab reports, short summaries, posters, quad charts, and technical presentations. Both courses include peer evaluation, revision exercises, and timed (on demand) writing assignments. The junior course includes assignments co-authored by a group as well as an individual report. An overview of both courses' assignments with course-end feedback from the students and the faculty is provided. Strengths and weaknesses are identified and recommendations for instructors seeking to implement similar technical communications assignments in their own courses are presented.

Implementation of the Spanish ERAS program in bariatric surgery.

PubMed

Ruiz-Tovar, Jaime; Muñoz, José Luis; Royo, Pablo; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose Manuel

2018-03-08

The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care. A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated. Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%. The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge.

Social network analysis for program implementation.

PubMed

Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Social Network Analysis for Program Implementation

PubMed Central

Valente, Thomas W.; Palinkas, Lawrence A.; Czaja, Sara; Chu, Kar-Hai; Brown, C. Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach. PMID:26110842

Practical experience from the Office of Adolescent Health's large scale implementation of an evidence-based Teen Pregnancy Prevention Program.

PubMed

Margolis, Amy Lynn; Roper, Allison Yvonne

2014-03-01

After 3 years of experience overseeing the implementation and evaluation of evidence-based teen pregnancy prevention programs in a diversity of populations and settings across the country, the Office of Adolescent Health (OAH) has learned numerous lessons through practical application and new experiences. These lessons and experiences are applicable to those working to implement evidence-based programs on a large scale. The lessons described in this paper focus on what it means for a program to be implementation ready, the role of the program developer in replicating evidence-based programs, the importance of a planning period to ensure quality implementation, the need to define and measure fidelity, and the conditions necessary to support rigorous grantee-level evaluation. Published by Elsevier Inc.

Modeling Open Architecture and Evolutionary Acquisition: Implementation Lessons from the ARCI Program for the Rapid Capability Insertion Process

DTIC Science & Technology

2009-04-22

Implementation Issues Another RCIP implementation risk is program management burnout . The ACRI program manager specifically identified the potential...of burnout in his program management team due to the repeated, intense Integration phases. To investigate the possibility and severity of this risk to...the ACRI simulation. This suggests that the burnout risk will be larger for RCIP than it was for ACRI. Successfully implementing a sustainable RCIP

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities. This Part 2 includes chapters on implementation guidance for operational configuration management, implementation guidance for design reconstitution, and implementation guidance for material condition and aging management. Appendices are included on design control, examples of design information, conduct of walkdowns, and content of design information summaries.

A Program Manager's Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs.

PubMed

Ryan, Gery W; Farmer, Carrie M; Adamson, David M; Weinick, Robin M

2014-01-01

Between 2001 and 2011, the U.S. Department of Defense has implemented numerous programs to support service members and their families in coping with the stressors from a decade of the longstanding conflicts in Iraq and Afghanistan. These programs, which address both psychological health and traumatic brain injury (TBI), number in the hundreds and vary in their size, scope, and target population. To ensure that resources are wisely invested and maximize the benefits of such programs, RAND developed a tool to help assess program performance, consider options for improvement, implement solutions, then assess whether the changes worked, with the intention of helping those responsible for managing or implementing programs to conduct assessments of how well the program is performing and to implement solutions for improving performance. Specifically, the tool is intended to provide practical guidance in program improvement and continuous quality improvement for all programs.

Evaluation of programs for adolescents with greater psychosocial needs: community-based Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Law, Moon Y M

2017-02-01

This study examined the perceptions of the Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social programmes) among Chinese secondary school students displaying greater psychosocial needs. Results showed that participants held positive views of program qualities, implementer qualities, as well as the perceived effectiveness of the program. Significant grade differences in terms of various indicators of satisfaction related to program qualities, implementer qualities, and program effectiveness were found. Correlation analyses showed that there were significant inter-relationships amongst program qualities, implementer qualities and program effectiveness. In line with the predictions, both program qualities and implementer qualities were significant predictors of perceived program effectiveness. The present study provides support for the perceived effectiveness of the Tier 2 Program of the Project P.A.T.H.S. in the community-based project context.

Translating an early childhood obesity prevention program for local community implementation: a case study of the Melbourne InFANT Program.

PubMed

Laws, R; Hesketh, K D; Ball, K; Cooper, C; Vrljic, K; Campbell, K J

2016-08-08

While there is a growing interest in the field of research translation, there are few published examples of public health interventions that have been effectively scaled up and implemented in the community. This paper provides a case study of the community-wide implementation of the Melbourne Infant, Feeding, Activity and Nutrition Trial (InFANT), an obesity prevention program for parents with infants aged 3-18 months. The study explored key factors influencing the translation of the Program into routine practice and the respective role of policy makers, researchers and implementers. Case studies were conducted of five of the eight prevention areas in Victoria, Australia who implemented the Program. Cases were selected on the basis of having implemented the Program for 6 months or more. Data were collected from January to June 2015 and included 18 individual interviews, one focus group and observation of two meetings. A total of 28 individuals, including research staff (n = 4), policy makers (n = 2) and implementers (n = 22), contributed to the data collected. Thematic analysis was conducted using cross case comparisons and key themes were verified through member checking. Key facilitators of implementation included availability of a pre-packaged evidence based program addressing a community need, along with support and training provided by research staff to local implementers. Partnerships between researchers and policy makers facilitated initial program adoption, while local partnerships supported community implementation. Community partnerships were facilitated by local coordinators through alignment of program goals with existing policies and services. Workforce capacity for program delivery and administration was a challenge, largely overcome by embedding the Program into existing roles. Adapting the Program to fit local circumstance was critical for feasible and sustainable delivery, however balancing this with program fidelity was a critical issue. The lack of ongoing funding to support translation activities was a barrier for researchers continued involvement in community implementation. Policy makers, researchers and practitioners have important and complementary roles to play in supporting the translation of effective research interventions into practice. New avenues need to be explored to strengthen partnerships between researchers and end users to support the integration of effective public health research interventions into practice.

[A Matter of Balance: strategy for implementation in Dutch homecare organizations].

PubMed

de Jonge, M C; van der Poel, A; van Haastregt, J C M; Du Moulin, M F T M; Zijlstra, G A R; Voordouw, I

2013-02-01

The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

Implementation notes on bdes(1). [data encryption implementation

NASA Technical Reports Server (NTRS)

Bishop, Matt

1991-01-01

This note describes the implementation of bdes, the file encryption program being distributed in the 4.4 release of the Berkeley Software Distribution. It implements all modes of the Data Encryption Standard program.

Implementation contexts of a Tuberculosis Control Program in Brazilian prisons

PubMed Central

de Oliveira, Luisa Gonçalves Dutra; Natal, Sonia; Camacho, Luiz Antonio Bastos

2015-01-01

OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects. METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons. RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases. CONCLUSIONS The implementation degree and its contexts – external and political-organizational dimensions – simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons. PMID:26465668

Some Methods for Evaluating Program Implementation.

ERIC Educational Resources Information Center

Hardy, Roy A.

An approach to evaluating program implementation is described. This approach includes the development of a project description which includes a structure matrix, sampling from the structure matrix, and preparing an implementation evaluation plan. The implementation evaluation plan should include: (1) verification of implementation of planned…

Investigating the criteria and processes used in the selection, implementation, and evaluation of STEM within K-12 education

NASA Astrophysics Data System (ADS)

Delp, Matthew J.

This study utilized survey research to investigate how school districts within K-12 education select, implement, and evaluate Science, Technology, Engineering, and Mathematics (STEM) programs. Thirty school districts within the Math and Science Collaborative located in Western Pennsylvania participated in this research. In addition to characterizing the STEM programs of the participating school districts, this study also analyzed the alignment of these programs to the components of comprehensive STEM programs and critical approaches to substantiate STEM program implementation as stated in the literature (Augustine, 2005; Bybee, 2010a, 2010b; Carnevale et al., 2011; DeJarnette, 2010; Epstein & Miller, 2011b; Gardner et al., 1983; Hossain & Robinson, 2011, 2012; Kuenzi, 2008). Findings suggest that the primary goal for school districts, as it relates to STEM program implementation, is to influence students' interest and pursuit of STEM-related careers and degrees. In order to achieve this goal, results of this study indicate the focus of STEM program implementation occurs with the greatest frequency at the middle school (grades seven and eight) level, are developed as an adaptation to the curriculum, and are very diverse from one school district to the next. In addition, findings suggest that although school districts maintain they aim to promote careers and degrees in STEM, districts rely on traditional methods of evaluating STEM program implementation (i.e. standardized test scores) and do not track the longitudinal impact their STEM programs as they related to degrees and careers in STEM. Furthermore, results indicate district STEM programs are not aligned to the characteristics of comprehensive STEM programs as defined by the literature. In order to address the misalignment of school district goals and evaluation processes involved in STEM program implementation and the absence of the characteristics commensurate with comprehensive STEM programs, this study has created a framework to guide school districts in STEM program selection, implementation, and evaluation.

Using a domestic and sexual violence prevention advocate to implement a dating violence prevention program with athletes.

PubMed

Jaime, M C D; Stocking, M; Freire, K; Perkinson, L; Ciaravino, S; Miller, E

2016-12-01

'Coaching Boys into Men' is an evidence-based dating violence prevention program for coaches to implement with male athletes. A common adaptation of this program is delivery by domestic violence and sexual violence prevention advocates instead of coaches. We explored how this implementer adaptation may influence athlete uptake of program messages and outcomes. Randomly, one school received the program delivered by an advocate while another school received the program delivered by coaches. Athletes completed baseline and follow-up surveys (n = 148), and a subset who received the advocate-led program participated in focus groups (four groups; n = 26). We compared changes in athlete attitudes and behaviors and conducted thematic analyses with qualitative data. We found no significant differences between athletes who received the program from the advocate versus their coaches. Athletes highlighted the advocate's delivery and role as a non-judgmental adult ally as qualities that influenced their uptake of program messages. The acceptability of the advocate-led program may be related to the implementer type along with specific implementer characteristics and delivery methods. Using advocates together with coaches as implementers could increase the reach of this program. Further study of best practices for Coaching Boys into Men adaptation is needed to guide program dissemination and sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

PubMed

Perrin, Karen M; Burke, Somer Goad; O'Connor, Danielle; Walby, Gary; Shippey, Claire; Pitt, Seraphine; McDermott, Robert J; Forthofer, Melinda S

2006-10-26

Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

How Setswana Cultural Beliefs and Practices on Sexuality Affect Teachers' and Adolescents' Sexual Decisions, Practices, and Experiences as well as HIV/AIDS and STI Prevention in Select Botswanan Secondary Schools.

PubMed

Nleya, Paul T; Segale, Emelda

2015-01-01

The article reports on the aspects of a Botswana Ministry of Education and Skills Development (MoE & SD) HIV/AIDS Instructional Television (ITV) project modeled on a similar HIV/AIDS program implemented in Brazil. This Teacher Capacity Building Project (TCBP) in Botswana is in its initial years of implementation. Its overall goal is to contribute to the prevention and mitigation of the impact of HIV and AIDS by strengthening the capacity of the education and communication sectors to deliver interactive, distance HIV/AIDS education primarily to teachers so that they act as agents of behavior change among the in-school youth. One of the components of the TCBP program is a live teacher education television HIV/AIDS program called Talk Back program. Talk Back is a collaborative effort of the MoE & SD and the Botswana national television station. The Talk Back program involves development and implementation of weekly 1 hour live HIV/AIDS education interactive TV broadcasts for teachers. The development of the live programs is guided by a curriculum that provides a wide range of themes related to HIV/AIDS and education. This article reports the results of a survey of a sample of teachers and students at junior secondary schools and senior secondary schools, first, on their views and opinions regarding the Talk Back program as a TCBP. Second, how Setswana cultural beliefs, myths, and practices on sexuality affect teachers' and adolescents' sexual decisions, practices, and experiences as well as HIV/AIDS and sexually transmitted infection prevention. A questionnaire survey and focus group interviews were used as data collection instruments in selected secondary schools. The findings of the study suggest that the Talk Back program has not met much success as a TCBP. The findings further suggest that several myths, beliefs, misconceptions, and attitudes about HIV/AIDS exist among Botswana teachers and students and thus make it difficult for the Talk Back program to impart the HIV/AIDS message successfully. Therefore, there is a need for more stakeholders in HIV/AIDS education, where appropriate learning techniques are used, to bring about the desired behavioral change. © The Author(s) 2013.

The Role of the Principal in the Implementation of a Gifted Education Program in a School.

ERIC Educational Resources Information Center

Taylor, C. A.

1987-01-01

The degree to which a principal provides appropriate and sufficient support for implementation of a gifted education program will determine the success of the program. Actions that can facilitate implementation, teacher use, and institutionalization and the effects of various managerial styles are discussed. Components of a gifted program are…

Implementing and Evaluating a Rural Community-Based Sexual Abstinence Program: Challenges and Solutions

ERIC Educational Resources Information Center

Stauss, Kimberly; Boyas, Javier; Murphy-Erby, Yvette

2012-01-01

Informing both program evaluation and practice research, this paper describes lessons learned during the planning, implementation, and pilot phases of an abstinence education program based in a rural community in a southern state in the USA. Although a number of challenges can emerge in successfully implementing and evaluating such a program in a…

Implementing Army Training Programs: An Overview for Managers. Research Report 1382.

ERIC Educational Resources Information Center

Gray, Wayne D.

The place and importance of implementation in the life cycle of Army training programs is frequently misunderstood. Typically, a program's life cycle is thought of as research, development, and use. If implementation is thought of at all, it is regarded as an event, not a process. Many worthwhile programs have failed because the implementation…

Free for All: A Case Study Examining Implementation Factors of One-to-One Device Programs

ERIC Educational Resources Information Center

Howard, Sarah K.; Rennie, Ellie

2013-01-01

Despite significant investment in school one-to-one device programs, little is known about which aspects of program implementation work and why. Through a comparison of two implementation models, adopter-diffusion and saturation, and using existing data from the One Laptop per Child Australia laptop program, we explored how factors of…

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-11-15

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-10-11

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

PubMed

Flash, Charlene A; Frost, Elizabeth L T; Giordano, Thomas P; Amico, K Rivet; Cully, Jeffrey A; Markham, Christine M

2018-04-01

HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. Copyright © 2018. Published by Elsevier Inc.

Demand-side management glossary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Isaksen, L.; Ignelzi, P.C.

1992-10-01

Demand-side management (DSM) plays an increasingly important role in helping utilities meet capacity needs while addressing important customer service issues. In implementing utility-specific programs, however, DSM professionals have created an entire vocabulary of words and phrases that are often used and interpreted in very different ways by people with similar utility planning backgrounds. Such inconsistent terminology can hamper the very communication DSM seeks to support. Thus, this report-the first of its kind-presents a glossary of DSM terms, grouped under five major categories: (1) utility systems, (2) programs and techniques, (3) costs, revenues, and rates, (4) modeling and analysis, and (5)more » marketing. An index facilitates the rapid search for key words. This glossary together with a complimentary report entitled, Electric Utility DSM Programs: Terminology and Reporting Formats attempts to define some of the most common terms used in DSM today.« less

Demand-side management glossary. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Isaksen, L.; Ignelzi, P.C.

1992-10-01

Demand-side management (DSM) plays an increasingly important role in helping utilities meet capacity needs while addressing important customer service issues. In implementing utility-specific programs, however, DSM professionals have created an entire vocabulary of words and phrases that are often used and interpreted in very different ways by people with similar utility planning backgrounds. Such inconsistent terminology can hamper the very communication DSM seeks to support. Thus, this report-the first of its kind-presents a glossary of DSM terms, grouped under five major categories: (1) utility systems, (2) programs and techniques, (3) costs, revenues, and rates, (4) modeling and analysis, and (5)more » marketing. An index facilitates the rapid search for key words. This glossary together with a complimentary report entitled, Electric Utility DSM Programs: Terminology and Reporting Formats attempts to define some of the most common terms used in DSM today.« less

Dropout policies and trends for students with and without disabilities.

PubMed

Kemp, Suzanne E

2006-01-01

Students with and without disabilities are dropping out of school at an alarming rate. However, the precise extent of the problem remains elusive because individual schools, school districts, and state departments of education often use different definitional criteria and calculation methods. In addition, specific reasons why students drop out continues to be speculative and minimal research exists validating current dropout prevention programs for students with and without disabilities. This study examined methods secondary school principals used to calculate dropout rates, reasons they believed students dropped out of school, and what prevention programs were being used for students with and without disabilities. Results indicated that school districts used calculation methods that minimized dropout rates, students with and without disabilities dropped out for similar reasons, and few empirically validated prevention programs were being implemented. Implications for practice and directions for future research are discussed.

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

PubMed

Ott, Carol H; Plach, Sandra K; Hewitt, Jeanne Beauchamp; Cashin, Susan E; Kelber, Sheryl; Cisler, Ron A; Weis, Jo M

2005-06-01

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Acoustics for the Deaf: Can You See Me Now?

NASA Astrophysics Data System (ADS)

Vongsawad, Cameron T.; Berardi, Mark L.; Neilsen, Tracianne B.; Gee, Kent L.; Whiting, Jennifer K.; Lawler, M. Jeannette

2016-09-01

Although acoustics examples and demonstrations can be an effective tool for engaging students in introductory physics classes and outreach, teaching principles of sound and vibration to the deaf and hard of hearing needs to be approached carefully. The deaf and hard of hearing have less intuition with sound but are no strangers to some of the effects of pressure, vibrations, and other basic principles that are related to sound. We recently expanded our "Sounds to Astound" outreach program and developed an acoustics demonstration program for 80 visiting deaf students mostly between the ages of 13 and 18. Both this experience, which had a "See and Feel" approach, similar to what was proposed by Lang, and a specialized planetarium program helped reinforce for the students the opportunities that exist for them in higher education. This paper describes some of the pedagogical underpinnings, the demonstrations, their implementation and lessons learned, and student responses.

Changes in misuse and abuse of prescription opioids following implementation of Extended-Release and Long-Acting Opioid Analgesic Risk Evaluation and Mitigation Strategy.

PubMed

Bucher Bartelson, Becki; Le Lait, M Claire; Green, Jody L; Cepeda, M Soledad; Coplan, Paul M; Maziere, Jean-Yves; Wedin, Gregory P; Dart, Richard C

2017-09-01

An unintended consequence of extended-release (ER) and long-acting (LA) prescription opioids is that these formulations can be more attractive to abusers than immediate-release (IR) formulations. The US Food and Drug Administration recognized these risks and approved the ER/LA Opioid Analgesic Risk Evaluation and Mitigation Strategy (ER/LA REMS), which has a goal of reducing opioid misuse and abuse and their associated consequences. The primary objective of this analysis is to determine whether ER/LA REMS implementation was associated with decreased reports of misuse and abuse. Data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS(R)) System Poison Center Program were utilized. Poison center cases are assigned a reason for exposure, a medical outcome, and a level of health care received. Rates adjusted for population and drug utilization were analyzed over time. RADARS System Poison Center Program data indicate a notable decrease in ER/LA opioid rates of intentional abuse and misuse as well as major medical outcomes or hospitalizations following implementation of the ER/LA REMS. While similar decreases were observed for the IR prescription opioid group, the decreasing rate for the ER/LA opioids exceeded the decreasing rates for the IR prescription opioids and was distinctly different than that for the prescription stimulants, indicating that the ER/LA REMS program may have had an additional effect on decreases in opioid abuse and intentional misuse beyond secular trends. Copyright © 2017 John Wiley & Sons, Ltd.

Accelerating Monte Carlo simulations with an NVIDIA ® graphics processor

NASA Astrophysics Data System (ADS)

Martinsen, Paul; Blaschke, Johannes; Künnemeyer, Rainer; Jordan, Robert

2009-10-01

Modern graphics cards, commonly used in desktop computers, have evolved beyond a simple interface between processor and display to incorporate sophisticated calculation engines that can be applied to general purpose computing. The Monte Carlo algorithm for modelling photon transport in turbid media has been implemented on an NVIDIA ® 8800 GT graphics card using the CUDA toolkit. The Monte Carlo method relies on following the trajectory of millions of photons through the sample, often taking hours or days to complete. The graphics-processor implementation, processing roughly 110 million scattering events per second, was found to run more than 70 times faster than a similar, single-threaded implementation on a 2.67 GHz desktop computer. Program summaryProgram title: Phoogle-C/Phoogle-G Catalogue identifier: AEEB_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEEB_v1_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Standard CPC licence, http://cpc.cs.qub.ac.uk/licence/licence.html No. of lines in distributed program, including test data, etc.: 51 264 No. of bytes in distributed program, including test data, etc.: 2 238 805 Distribution format: tar.gz Programming language: C++ Computer: Designed for Intel PCs. Phoogle-G requires a NVIDIA graphics card with support for CUDA 1.1 Operating system: Windows XP Has the code been vectorised or parallelized?: Phoogle-G is written for SIMD architectures RAM: 1 GB Classification: 21.1 External routines: Charles Karney Random number library. Microsoft Foundation Class library. NVIDA CUDA library [1]. Nature of problem: The Monte Carlo technique is an effective algorithm for exploring the propagation of light in turbid media. However, accurate results require tracing the path of many photons within the media. The independence of photons naturally lends the Monte Carlo technique to implementation on parallel architectures. Generally, parallel computing can be expensive, but recent advances in consumer grade graphics cards have opened the possibility of high-performance desktop parallel-computing. Solution method: In this pair of programmes we have implemented the Monte Carlo algorithm described by Prahl et al. [2] for photon transport in infinite scattering media to compare the performance of two readily accessible architectures: a standard desktop PC and a consumer grade graphics card from NVIDIA. Restrictions: The graphics card implementation uses single precision floating point numbers for all calculations. Only photon transport from an isotropic point-source is supported. The graphics-card version has no user interface. The simulation parameters must be set in the source code. The desktop version has a simple user interface; however some properties can only be accessed through an ActiveX client (such as Matlab). Additional comments: The random number library used has a LGPL ( http://www.gnu.org/copyleft/lesser.html) licence. Running time: Runtime can range from minutes to months depending on the number of photons simulated and the optical properties of the medium. References:http://www.nvidia.com/object/cuda_home.html. S. Prahl, M. Keijzer, Sl. Jacques, A. Welch, SPIE Institute Series 5 (1989) 102.

Implementing a Paid Leave Policy for Graduate Students at UW - Madison: The Student Perspective

NASA Astrophysics Data System (ADS)

Gosnell, Natalie M.

2013-01-01

In 2010 the University of Wisconsin - Madison Astronomy Department developed and implemented a departmental paid leave policy for our graduate students, even though the university lacks a campus-wide policy and cannot provide institutional funding for such programs. This policy includes 12 weeks of paid leave in event of a medical emergency or chronic medical condition, as well as paid parental leave for both male and female graduate research assistants. (The policy in its entirety can be found at http://www.astro.wisc.edu/grad-students/policies-procedures/medical-and-family-leave-policy.) This is the first of two presentations describing our policy implementation using a "bottom-up" approach, beginning with the graduate students. I will present the perspective of the graduate students who led the effort and will discuss the steps we took to put our policy in place, from the conception of the plan to the full implementation. These steps included identifying faculty allies, becoming knowledgeable about university policies and resources, involving department staff, and anticipating procedural and bureaucratic hurdles in order to come up with creative solutions in advance. Although each individual institution and department's path to implementing a similar plan will be unique, we hope the methods used to implement our policy at UW - Madison may serve as an example.

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

PubMed

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

Long Live Love+: Evaluation of the Implementation of an Online School-Based Sexuality Education Program in the Netherlands

ERIC Educational Resources Information Center

van Lieshout, Sanne; Mevissen, Fraukje; de Waal, Esri; Kok, Gerjo

2017-01-01

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to…

Creation and Implementation of a Workforce Development Pipeline Program at MSFC

NASA Technical Reports Server (NTRS)

Hix, Billy

2003-01-01

Within the context of NASA's Education Programs, this Workforce Development Pipeline guide describes the goals and objectives of MSFC's Workforce Development Pipeline Program as well as the principles and strategies for guiding implementation. It is designed to support the initiatives described in the NASA Implementation Plan for Education, 1999-2003 (EP-1998-12-383-HQ) and represents the vision of the members of the Education Programs office at MSFC. This document: 1) Outlines NASA s Contribution to National Priorities; 2) Sets the context for the Workforce Development Pipeline Program; 3) Describes Workforce Development Pipeline Program Strategies; 4) Articulates the Workforce Development Pipeline Program Goals and Aims; 5) List the actions to build a unified approach; 6) Outlines the Workforce Development Pipeline Programs guiding Principles; and 7) The results of implementation.

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

PubMed

Lyon, Cheryl

2007-12-01

Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion  The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.

Sustained Implementation Support Scale: Validation of a Measure of Program Characteristics and Workplace Functioning for Sustained Program Implementation.

PubMed

Hodge, Lauren M; Turner, Karen M T; Sanders, Matthew R; Filus, Ania

2017-07-01

An evaluation measure of enablers and inhibitors to sustained evidence-based program (EBP) implementation may provide a useful tool to enhance organizations' capacity. This paper outlines preliminary validation of such a measure. An expert informant and consumer feedback approach was used to tailor constructs from two existing measures assessing key domains associated with sustained implementation. Validity and reliability were evaluated for an inventory composed of five subscales: Program benefits, Program burden, Workplace support, Workplace cohesion, and Leadership style. Exploratory and confirmatory factor analysis with a sample of 593 Triple P-Positive Parenting Program-practitioners led to a 28-item scale with good reliability and good convergent, discriminant, and predictive validity. Practitioners sustaining implementation at least 3 years post-training were more likely to have supervision/peer support, reported higher levels of program benefit, workplace support, and positive leadership style, and lower program burden compared to practitioners who were non-sustainers.

Tailoring an educational program on the AHRQ Patient Safety Indicators to meet stakeholder needs: lessons learned in the VA.

PubMed

Shin, Marlena H; Rivard, Peter E; Shwartz, Michael; Borzecki, Ann; Yaksic, Enzo; Stolzmann, Kelly; Zubkoff, Lisa; Rosen, Amy K

2018-02-14

Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI). The goal of this study was to develop an educational program and tailor it to stakeholders' needs. In this paper, we share what we learned from this program development process. Our study population included key VA stakeholders involved in reviewing performance reports and prioritizing and initiating quality/safety initiatives. A pre-program formative evaluation through telephone interviews and web-based surveys assessed stakeholders' educational needs/interests. Findings from the formative evaluation led to development and implementation of a cyberseminar-based program, which we tailored to stakeholders' needs/interests. A post-program survey evaluated program participants' perceptions about the PSI educational program. Interview data confirmed that the concepts we had developed for the interviews could be used for the survey. Survey results informed us on what program delivery mode and content topics were of high interest. Six cyberseminars were developed-three of which focused on two content areas that were noted of greatest interest: learning how to use PSIs for monitoring trends and understanding how to interpret PSIs. We also used snapshots of VA PSI reports so that participants could directly apply learnings. Although initial interest in the program was high, actual attendance was low. However, post-program survey results indicated that perceptions about the program were positive. Conducting a formative evaluation was a highly important process in program development. The useful information that we collected through the interviews and surveys allowed us to tailor the program to stakeholders' needs and interests. Our experiences, particularly with the formative evaluation process, yielded valuable lessons that can guide others when developing and implementing similar educational programs.